Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis

BMC Pregnancy and Childbirth

Nakeisha A. Lodge-Tulloch¹  Laura Gaudet¹  Jessica Pudwell¹  Graeme N. Smith¹  Maria P. Velez²  Flavia T. S. Elias³  Mark Walker⁴ 

[1] Department of Obstetrics and Gynecology, Kingston General Hospital, Queen’s University, Victory 4, 76 Stuart St, K7L 2V7, Kingston, Ontario, Canada;Department of Obstetrics and Gynecology, Kingston General Hospital, Queen’s University, Victory 4, 76 Stuart St, K7L 2V7, Kingston, Ontario, Canada;Department of Public Health Sciences, Queen’s University, 62 Fifth Field Company Lane, K7L 3N6, Kingston, Ontario, Canada;Department of Obstetrics and Gynecology, Kingston General Hospital, Queen’s University, Victory 4, 76 Stuart St, K7L 2V7, Kingston, Ontario, Canada;Health Technology Assessment Program, Oswaldo Cruz Foundation, Brasilia, Brazil;Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 451 Smyth Road, K1H 8M5, Ottawa, Ontario, Canada;

关键词: Elective caesarean section;    Emergent caesarean section;    Frozen embryo transfer;    Fresh embryo transfer;    In-vitro fertilization (IVF);    Intracytoplasmic sperm injection (ICSI);    Maternal outcomes;   

DOI  :  10.1186/s12884-021-03711-x

来源: Springer

【 摘 要 】

BackgroundCaesarean section rates are higher among pregnancies conceived by assisted reproductive technology (ART) compared to spontaneous conceptions (SC), implying an increase in neonatal and maternal morbidity. We aimed to compare caesarean section rates in ART pregnancies versus SC, overall, by indication (elective versus emergent), and by type of ART treatment (in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), fresh embryo transfer, frozen embryo transfer) in a systematic review and meta-analysis.MethodsWe searched Medline, EMBASE and CINAHL databases using the OVID Platform from 1993 to 2019, and the search was completed in January 2020. The eligibility criteria were cohort studies with singleton conceptions after in-vitro fertilization and/or intracytoplasmic sperm injection using autologous oocytes versus spontaneous conceptions. The study quality was assessed using the Newcastle Ottawa Scale and GRADE approach. Meta-analyses were performed using odds ratios (OR) with a 95% confidence interval (CI) using random effect models in RevMan 5.3, and I-squared (I2) test > 75% was considered as high heterogeneity.ResultsOne thousand seven hundred fifty studies were identified from the search of which 34 met the inclusion criteria. Compared to spontaneous conceptions, IVF/ICSI pregnancies were associated with a 1.90-fold increase of odds of caesarean section (95% CI 1.76, 2.06). When stratified by indication, IVF/ICSI pregnancies were associated with a 1.91-fold increase of odds of elective caesarean section (95% CI 1.37, 2.67) and 1.38-fold increase of odds of emergent caesarean section (95% CI 1.09, 1.75). The heterogeneity of the studies was high and the GRADE assessment moderate to low, which can be explained by the observational design of the included studies.ConclusionsThe odds of delivering by caesarean section are greater for ART singleton pregnancies compared to spontaneous conceptions. Preconception and pregnancy care plans should focus on minimizing the risks that may lead to emergency caesarean sections and finding strategies to understand and decrease the rate of elective caesarean sections.

【 授权许可】

CC BY