Society for Maternal-Fetal Medicine Consult Series #60: Management of pregnancies resulting from in vitro fertilization

Ghidini, Alessandro; Gandhi, Manisha; McCoy, Jennifer; Kuller, Jeffrey A.

doi:10.1016/j.ajog.2021.11.001

Cited by 20 publications

(16 citation statements)

References 112 publications

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“…While ART is widely recognized as a risk factor of vasa previa [ 9 , 17 , 18 , 19 , 53 ], our systematic review revealed that only one comparative study compared the rate of vasa previa between ART and non-ART pregnancies. Although a recent retrospective study was not included in this systematic review owing to the out-of-search date, this study compared the patient background between women with vasa previa and without vasa previa who were detected on the 20-week anomaly scan [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Abnormal cord insertion (ACI) is associated with adverse obstetric outcomes; however, the relationship between ACI and assisted reproductive technology (ART) has not been examined in a meta-analysis. This study examines the association between ACI and ART, and delivery outcomes of women with ACI. A systematic review was conducted, and 16 studies (1990–2021) met the inclusion criteria. In the unadjusted pooled analysis (n = 10), ART was correlated with a higher rate of velamentous cord insertion (VCI) (odds ratio (OR) 2.14, 95% confidence interval (CI) 1.64–2.79), marginal cord insertion (n = 6; OR 1.58, 95%CI 1.26–1.99), and vasa previa (n = 1; OR 10.96, 95%CI 2.94–40.89). Nevertheless, the VCI rate was similar among the different ART types (blastocyst versus cleavage-stage transfer and frozen versus fresh embryo transfer). Regarding the cesarean delivery (CD) rate, women with VCI were more likely to have elective (n = 3; OR 1.13, 95%CI 1.04–1.22) and emergent CD (n = 5; OR 1.93, 95%CI 1.82–2.03). In conclusion, ART may be correlated with an increased prevalence of ACI. However, most studies could not exclude confounding factors; thus, further studies are warranted to characterize ART as a risk factor for ACI. In women with ACI, elective and emergent CD rates are high.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…[3] In this case, the diagnosis was confirmed by symptoms and imaging after admission. Aspirin [4,5] and low-molecular heparin have been reported to increase the rate of embryo implantation, [6] so the patient was treated with both enoxaparin and aspirin anticoagulants at an outside hospital.…”

Section: Discussionmentioning

confidence: 99%

A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET

Luo¹,

Shen²,

et al. 2023

Medicine

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Introduction: Ovarian hyperstimulation syndrome (OHSS) is a common complication during assisted conception treatment, mostly seen in patients with ovarian hyperresponsiveness such as polycystic ovary syndrome, especially in post-invitro fertilization and embryo transfer (IVF-ET) pregnancies. Its main symptoms are abdominal distension, abdominal pain, nausea and vomiting with ascites, pleural fluid, leukocytosis, hemoconcentration and hypercoagulation. This disease is a self-limiting disease and can be gradually cured by rehydration, albumin infusion and correction of electrolyte disorders in moderate to severe cases. Luteal rupture is a more common gynecological emergency abdomen. The combination of twin pregnancy, OHSS and ruptured corpus luteum is very rare. We successfully avoided the stimulation of the risk of pregnancy abortion by surgical exploration through dynamic ultrasound monitoring and vital signs observation in the absence of experience in primary care, and the patient hard-won twin pregnancy was successfully treated conservatively. Patient concerns: The patient is a 30-year-old post-IVF-ET woman with an established twin pregnancy, OHSS and sudden onset of lower abdominal pain. Diagnosis: Twin pregnancy, OHSS combined with ruptured corpus luteum. Interventions: Rehydration, albumin infusion, low molecular heparin for thromboprophylaxis, luteinizing support, ambulatory ultrasound monitoring. Outcomes: After more than 10 days of standardized treatment for OHSS, dynamic ultrasound monitoring and close observation of vital signs, the patient was discharged cured of her condition and is continuing her pregnancy. Conclusion: Our case shows that the possibility of acute abdominal rupture of the corpus luteum is still present in the case of combined OHSS in pregnancy, and that some patients with corpus luteum rupture can heal spontaneously during close testing to avoid the increased risk of miscarriage with surgical exploration.

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“…With regard to vasa previa, previous studies have reported an association between ART and an increased rate of vasa previa [ 2 , 21 , 24 , 25 , 55 , 56 , 57 , 58 ]. However, these were not classified as type I or type II vasa previa.…”

Section: Discussionmentioning

confidence: 99%

“…Although ART has been reported as a risk factor for vasa previa [ 2 , 21 , 24 , 25 , 58 ], our previous study found only one comparative study compared the rate of vasa previa between women who conceived by ART and without ART [ 73 ], and the study did not consider the differences in the type of vasa previa. The majority of type I vasa previa consists of a combination of a low-lying placenta and velamentous cord insertion [ 1 , 2 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Society for Maternal-Fetal Medicine Consult Series #60: Management of pregnancies resulting from in vitro fertilization

Cited by 20 publications

References 112 publications

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

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

A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET

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

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