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Assisted fertilization and breech delivery: risks and obstetric management
Liv Bente Romundstad1, Pål R Romundstad, Arne Sunde
1Department of Obstetrics and Gynaecology, IVF Unit, St Olav's University Hospital, Trondheim NO-7006, Trondheim, Norway. libero@ntnu.no
Human Reproduction (Oxford, England)
|August 25, 2009
Summary
Assisted reproduction technology (ART) pregnancies had a higher risk of breech presentation, but this was explained by factors like lower parity and shorter gestation. Obstetric management for ART pregnancies is becoming more standard.
Area of Science:
- Reproductive Medicine
- Obstetrics
- Perinatal Epidemiology
Background:
- Assisted reproduction technology (ART) use is linked to increased breech presentation risk.
- Investigating confounding factors in ART pregnancies is crucial to understand this association.
Purpose of the Study:
- To determine if factors differing between ART and spontaneously conceived pregnancies explain the elevated risk of breech presentation in ART.
- To analyze obstetric management trends for breech and cephalic presentations in ART versus spontaneous pregnancies.
Main Methods:
- Population-based cohort study of 1,209,151 singleton pregnancies (1984-2006).
- Comparison of breech presentation risk between 8,229 ART and spontaneously conceived pregnancies.
- Binominal regression used for risk ratio estimation, adjusted for maternal age, parity, gestational length, and birth year.
Main Results:
- Crude analysis showed a 48% higher risk of breech presentation in ART pregnancies (RR: 1.48).
- Adjusted analysis fully attenuated the difference (RR: 0.97), with parity and gestational length being key factors.
- ART pregnancies showed higher rates of Cesarean sections and induced deliveries, but these trends converged with spontaneous pregnancies over time.
Conclusions:
- The increased risk of breech presentation in ART pregnancies is mediated by lower parity and shorter gestational length.
- Obstetric management for ART pregnancies is increasingly aligning with standard surveillance practices.
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