Assisted Reproductive Technique and Abnormal Cord Insertion: A Systematic Review and Meta-Analysis

Zhang

Journal of Environmental and Public Health

2022

Objective. The objective of this study is to evaluate feasibility and accuracy of transabdominal color Doppler ultrasound (TA-CDUS) and transvaginal color Doppler ultrasound (TV-CDUS) as screening methods for pregnant women with vasa previa (VP) and velamentous cord insertion (VCI). Methods. A retrospective diagnostic accuracy study was performed on 5,434 pregnant women from 2018 to 2021, who underwent both TA-CDUS and TV-CDUS. Diagnostic performance of TA-CDUS and TV-CDUS was determined using specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and positive and negative likelihood ratios (LR+ and LR-), using the delivery information (gross examination) as the “Gold-standard”. Patient records were reviewed for demographics and diagnosis. Results. The combination of VP and VCI was diagnosed in 37/5434 (0.68%) women at delivery. The sensitivity, specificity, PPV, NPV, and overall test accuracy of TA-CDUS were 72.97%, 99.85%, 77.14%, 99.81%, and 99.67%, respectively, for diagnosing VP with VCI. The corresponding values for TV-CDUS were 89.19%, 99.87%, 82.50%, 99.93%, and 99.80%, respectively. Moreover, the sensitivity of combination of TA-CDUS and TA-CDUS in determining VP with VCI was 97.30%, specificity 99.98%, PPV 97.30%, NPV 99.98%, and accuracy 99.96%. No significant difference in the misdiagnosis and missed diagnosis was found between the examination by TA-CDUS and TV-CDUS. Conclusions. Both TA-CDUS and TV-CDUS can be acceptable diagnostic tools for assessment of pregnant women with VP and VCI, with a better application of TV-CDUS with higher accuracy. The combination of TA-CDUS and TV-CDUS could provide an objective imaging basis for choosing clinical treatment strategies and predicting prognosis.

Section: Introductionmentioning

confidence: 99%

[Retracted] The Diagnostic Accuracy of Transabdominal and Transvaginal Color Doppler Ultrasound for Pregnant Women with Vasa Previa and Velamentous Cord Insertion

Zhang

Journal of Environmental and Public Health

2022

“…The results of the present systematic review showed that type II vasa previa accounts for approximately 20% of all vasa previa cases. A recent study reported that the incidence of vasa previa may be increasing with the increasing number of ART pregnancies [ 54 ]; however, the trends of type II vasa previa are still unknown. If ART pregnancy is associated with an increased prevalence of abnormal placenta; the incidence of type II vasa previa is expected to increase.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike bilobed placenta and succenturiate lobe, the development of velamentous cord insertion has been well discussed, and two major hypotheses have been proposed (trophotropism hypothesis and polarity hypothesis) [ 54 , 62 ]. The trophotropism hypothesis was proposed to explain the development of velamentous cord insertion.…”

Section: Discussionmentioning

confidence: 99%

“…The placenta in early pregnancy migrates with proceeding gestational weeks for a better blood supply from a more vascularized area, and these migrations may lead to an unprotected cord with velamentous cord insertion [ 68 , 69 , 70 ]. In our previous meta-analysis [ 54 ], ART was associated with an increased rate of velamentous cord insertion. These results appear to support the trophotropism theory, because ART disrupts the precise timeline of biological action required for blastocyst implantation at multiple stages [ 62 , 71 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Characteristics and Obstetric Outcomes of Type II Vasa Previa: Systematic Review and Meta-Analysis

et al. 2022

Self Cite

Vasa previa is a rare fetal life-threatening obstetric disease classified into types I and II. This study aimed to examine the characteristics and obstetric outcomes of type II vasa previa. A systematic review was performed, and 20 studies (1998–2022) were identified. The results from six studies showed that type II vasa previa accounted for 21.3% of vasa previa cases. The characteristics and obstetric outcomes (rate of assisted reproductive technology (ART), antenatal diagnosis, emergent cesarean delivery, maternal transfusion, gestational age at delivery, and neonatal mortality) were compared between type I and II vasa previa, and all outcomes of interest were similar. The association between ART and abnormal placenta (bilobed placenta or succenturiate lobe) was examined in three studies, and the results were as follows: (i) increased rate of succenturiate lobes (ART versus non-ART pregnancy; OR (odds ratio) 6.97, 95% confidence interval (CI) 2.45–19.78); (ii) similar rate of abnormal placenta (cleavage-stage versus blastocyst embryo transfer); (iii) increased rate of abnormal placenta (frozen versus fresh embryo transfer; OR 2.97, 95%CI 1.10–7.96). Although the outcomes of type II vasa previa appear to be similar to those of type I vasa previa, the current evidence is insufficient for a robust conclusion.

“…Previous publications con rmed that vasa previa [24][25][26][27] and abnormal cord insertion [27][28][29] are more frequent in pregnancies conceived by assisted reproductive technology. Nonetheless, no study has further compared the odds of abnormal umbilical cord after PGT technology versus IVF/ICSI technology.…”

Section: Discussionmentioning

confidence: 99%

Trophectoderm biopsy is associated with adverse obstetric outcomes rather than neonatal outcomes

Zhang

Zhou

et al. 2022

Preprint

Background: With the wide application of preimplantation genetic testing (PGT) with trophectoderm (TE) biopsy, the safety of PGT has always been a concern. Since TE subsequently forms the placenta, it is speculated that the removal of these cells was associated with adverse obstetrical or neonatal outcomes after single frozen-thawed blastocyst transfer (FBT). Previous studies report contradictory findings with respect to TE biopsy and obstetric and neonatal outcomes. Methods: We conducted a retrospective cohort study including 720 patients with singleton pregnancies from single FBT cycles who delivered at the same university-affiliated hospital between January 2019 and March 2022. The cohorts were divided into two groups: the PGT group (blastocysts with TE biopsy, n=223) and the control group (blastocysts without biopsy, n=497). The PGT group was matched with the control group by propensity score matching (PSM) analysis at a ratio of 1:2. The enrolled sample sizes in the two groups were 215 and 385, respectively. Results: Patient demographic characteristics were comparable between the groups after PSM. Patients in the PGT group had significantly higher rates of hypertensive disorders of pregnancy (HDP) (13.5 vs. 8.8%, adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.02–3.05, P = 0.043), gestational hypertension (6.0 vs. 2.6%, aOR 2.65, 95% CI 1.12–6.30, P = 0.027) and abnormal umbilical cord (13.0 vs. 7.8%, aOR 1.83, 95% CI 1.05–3.17, P = 0.032). However, the occurrence of premature rupture of membranes (PROM) (12.1 vs. 19.7%, aOR 0.57, 95% CI 0.35–0.93, P = 0.025) was significantly lower in biopsied blastocysts than in unbiopsied embryos. There were no significant differences in regard to other obstetric and neonatal outcomes between the two groups. Conclusions: Trophectoderm biopsy is a safe approach, as the neonatal outcomes from biopsied and unbiopsied embryos were comparable. Furthermore, PGT is associated with higher risks of HDP, gestational hypertension, and abnormal umbilical cord but has a protective effect on PROM.