Pregnancy Risk Factors Research Articles

Pregnancy outcomes in Chinese women with mechanical heart valves receiving warfarin treatment throughout pregnancy: 14-year experience

ObjectiveThe purpose was to evaluate pregnancy outcomes and risk factors associated with fetal complications in Chinese pregnant women with mechanical heart valves (MHVs) taking low-dose warfarin, aiming to fill in the research gap of this area. MethodsBetween June 2010 and Aug 2023, 122 patients with MHVs who had 151 pregnancies and received warfarin throughout pregnancy were included. We compared them with 302 paired pregnancies without warfarin treatment. Binary logistic regression analyses were performed to explore risk predictors of fetal complications. ResultsPregnancy loss rate was 37.1 % in women taking warfarin, compared to only 4.6 % for those without warfarin exposure in pregnancy (RR = 8.00, 95 % CI: 4.61–13.90). In pregnant women with MHVs, there were 34 spontaneous abortions, 22 stillbirths and 1 neonatal malformation. In the first, second and third pregnant trimesters of women with MHVs, fetal complication incidences were 19.2 %, 9.9 % and 8.0 %, respectively. 86.0 % of fetal complications occurred in women taking a warfarin dose ≤5 mg/d, accounting for 94.0 % of the total population. The newborns' birth weight, gestational age and 1-minute Apgar score were significantly lower in pregnancies treated with warfarin compared to those without warfarin exposure. Only 2.0 % of postpartum hemorrhage and no thrombosis or maternal mortality data were collected in pregnant women on warfarin in this study. ConclusionMost Chinese pregnant women take a warfarin daily dose ≤5 mg and they might have only around 60 % chance of giving birth to a live baby without maternal complications.

Pregnancy outcomes and risk factors of serious cardiovascular adverse events in pregnant women with pulmonary hypertension.

Pregnancy outcomes and risk factors of serious cardiovascular adverse events in pregnant women with pulmonary hypertension.

Association between tuberculosis and pregnancy outcomes: a retrospective cohort study of women in Cape Town, South Africa

BackgroundTuberculosis (TB) remains a leading cause of mortality among women of childbearing age and a significant contributor to maternal mortality. Pregnant women with TB are at high risk of adverse...

Family-Based Pregnancy Risk Detection With Family-Centered Maternity Care

The ability of pregnant women to detect early high-risk pregnancies is still below average which is one of the causes of complications that can endanger the well-being of the mother and fetus. Family involvement and other social sources of support in the perinatal period are associated with the detection and reduction of pregnancy risk factors. Approach to families in early dedetermination of pregnancy risk can be done with Family Center Maternity Care (FCMC). FCMC is care designed to meet the informational, social, emotional, comfort, and support needs of normal pregnant women during pregnancy and childbirth. The purpose of this study was to determine the determinants of early detection factors for pregnant women with family-based risk with FCMC. This type of research is quantitative and non-experimental with an analytical observational design through a cross-sectional approach. The population in this study was all pregnant women who experienced risk factors in the Kedungwuni I, Kedungwuni II, Bojong Health Center Area as many as 103 pregnant women. The sampling technique used is the Total Population. The results of this study show that there is a positive and statistically significant relationship of knowledge with the implementation of early detection. Pregnant women who have good knowledge have a likelihood of carrying out early detection of pregnancy risk well by 3,193 times higher than respondents with less knowledge (OR=3,193; CI 95%=1.123-9.078; p=0.029). It is hoped that health workers, especially midwives, can involve their families, especially for early detection of the risk of pregnant women so that pregnant women get optimal health services.

Investigation of amino acid profile alterations in maternal serum for early diagnosis of anembryonic pregnancy with high performance liquid chromatography-mass spectrometry

BackgroundAnembryonic pregnancy affects 12–15 % of clinically recognized pregnancies and a previous anembryonic pregnancy is an independent risk factor for future anembryonic pregnancy. This study aimed to investigate alternations in maternal amino acid profiles and analyze the diagnostic accuracy of amino acid biomarkers for anembryonic pregnancy in the early stage. MethodsFasting serum from anembryonic pregnancy patients (n = 103) and healthy pregnancies (n = 97) was collected, and amino acid concentrations were determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC–MS/MS). A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of each of the amino acid biomarkers and the amino acid profile index for anembryonic pregnancy screening. ResultsThe concentrations of 15 amino acids were significantly different between anembryonic pregnancy patients and healthy controls, and most of them were significantly higher at 7 weeks’ gestational age in anembryonic pregnancy subjects. The area under the curve (AUC) based on an amino acid profile index combined with alanine, citrulline, aspartic acid, threonine, serine and isoleucine was 0.90 (sensitivity 82.76 %, specificity 83.64 %) for distinguishing early anembryonic pregnancy from healthy controls. ConclusionMaternal serum amino acid concentrations were significantly elevated in anembryonic pregnancy patients. The diagnostic potential of amino aicds for anembryonic pregnancy was verified, and the diagnostic efficiency was improved in the use of the amino acid profile index. The amino acid profile is expected to be applied for the risk screening of early-stage of anembryonic pregnancy in the future.

Birth asphyxia and its association with grand multiparity and referral among hospital births: A prospective cross-sectional study in Benin, Malawi, Tanzania and Uganda.

Birth asphyxia is a leading cause of neonatal mortality in sub-Saharan Africa. The relationship to grand multiparity (GM), a controversial pregnancy risk factor, remains largely unexplored, especially in the context of large multinational studies. We investigated birth asphyxia and its association with GM and referral in Benin, Malawi, Tanzania and Uganda. This was a prospective cross-sectional study. Data were collected using a perinatal e-Registry in 16 hospitals (four per country). The study population consisted of 80 663 babies (>1000 g, >28 weeks' gestational age) delivered between July 2021 and December 2022. The primary outcome was birth asphyxia, defined by 5-minute appearance, pulse, grimace, activity and respiration score <7. A multilevel and stratified multivariate logistic regression was performed with GM (parity ≥5) as exposure, and birth asphyxia as outcome. An interaction between referral (none, prepartum, intrapartum) and GM was also evaluated as a secondary outcome. All models were adjusted for confounders. Pan African Clinical Trial Registry 202006793783148. Birth asphyxia was present in 7.0% (n = 5612) of babies. More babies with birth asphyxia were born to grand multiparous women (11.9%) than to other parity groups (≤7.6%). Among the 76 850 cases included in the analysis, grand multiparous women had a 1.34 times higher odds of birth asphyxia (95% confidence interval [CI] 1.17-1.54) vs para one to two. Grand multiparous women referred intrapartum had the highest probability of asphyxiation (13.02%, 95% CI 9.34-16.69). GM increased odds of birth asphyxia in Benin (odds ratio [OR] 1.37, 95% CI 1.13-1.68) and Uganda (OR 1.29, 95% CI 1.02-1.64), but was non-significant in Tanzania (OR 1.44, 95% CI 0.81-2.56) and Malawi (OR 0.98, 95% CI 0.67-1.44). There is some evidence of an increased risk of birth asphyxia for grand multiparous women having babies at hospitals, especially following intrapartum referral. Antenatal counseling should recognize grand multiparity as higher risk and advise appropriate childbirth facilities. Findings in Malawi suggest an advantage of health systems configuration requiring further exploration.

Diving into CDC pregnancy data in the United States: longitudinal study and interactive application.

Preterm birth (PTB) is a major determinant of neonatal mortality, morbidity, and childhood disability. In this article, we present a longitudinal analysis of the risk factors associated with PTB and how they have varied over the years: starting from 1968 when the CDC first started, reporting the natality data, up until 2021. Along with this article, we are also releasing an RShiny web application that will allow for easy consumption of this voluminous dataset by the research community. Further, we hope this tool can aid clinicians in the understanding and prevention of PTB. This study used the CDC Natality data from 1968 to 2021 to analyze trends in PTB outcomes across the lens of various features, including race, maternal age, education, and interval length between pregnancies. Our interactive RShiny web application, CDC NatView, allows users to explore interactions between maternal risk factors and maternal morbidity conditions and the aforementioned features. Our study demonstrates how CDC data can be leveraged to conduct a longitudinal analysis of natality trends in the United States. Our key findings reveal an upward trend in late PTBs, which is concerning. Moreover, a significant disparity exists between African American and White populations in terms of PTB. These disparities persist in other areas, such as education, body-mass index, and access to prenatal care later in pregnancy. Another notable finding is the increase in maternal age over time. Additionally, we confirm that short interpregnancy intervals (IPIs) are a risk factor for PTBs. To facilitate the exploration of pregnancy risk factors, infections, and maternal morbidity, we developed an open-source RShiny tool called CDC NatView. This software offers a user-friendly interface to interact with and visualize the CDC natality data, which constitutes an invaluable resource. In conclusion, our study has shed light on the rise of late PTBs and the persistent disparities in PTB rates between African American and White populations in the US. The increase in maternal age and the confirmation of a short IPI as a risk factor for PTB are noteworthy findings. Our open-source tool, CDC NatView, can be a valuable resource for further exploration of the CDC natality data to enhance our understanding of pregnancy risk factors and the interaction of PTB outcomes and maternal morbidities.

Risk factors of ectopic pregnancy after in vitro fertilization-embryo transfer in Chinese population: A meta-analysis.

The prevalence of ectopic pregnancy after assisted reproduction is notably high, posing a significant threat to the life safety of pregnant women. Discrepancies in published results and the lack of a comprehensive description of all risk factors have led to ongoing uncertainties concerning ectopic pregnancy after assisted reproduction. This study aimed to understand the risk factors for ectopic pregnancy after in vitro fertilization-embryo transfer in the Chinese population and provide a reference for targeted prevention and treatment. A comprehensive search of the China National Knowledge Infrastructure, Wang fang Database, China Science Technology Journal Database, Chinese Biomedical Literature Database, PubMed, Web of Science, and Embase was conducted to identify relevant literature on the risk factors for ectopic pregnancy in Chinese women after assisted reproductive technology in Chinese women. A meta-analysis of the included studies was performed using Stata17. Overall, 34 articles were included in the analysis. The risk factors for ectopic pregnancy after in vitro fertilization-embryo transfer in the Chinese population included a thin endometrium on the day of HCG administration and embryo transplantation, a history of ectopic pregnancy, secondary infertility, a history of induced abortion, polycystic ovary syndrome, decreased ovarian reserve, tubal factor infertility, cleavage stage embryo transfer, fresh embryo transfer, artificial cycle protocols, elevated estradiol levels on the day of human chorionic gonadotropin administration, a history of tubal surgery, two or more number of embryo transfers, previous pregnancy history, and a history of pelvic surgery. This study clarified the factors influencing ectopic pregnancy after in vitro fertilization and embryo transfer in the Chinese population, focusing on high-risk groups. Targeted and personalized intervention measures should be adopted to prevent and detect the disease early to reduce its incidence and harm. The protocol for this view was registered in PROSPERO (CRD42023414710).

Risk factors and glycaemic control in small-for-gestational-age infants born to mothers with gestational diabetes mellitus: a case–control study using propensity score matching based on a large population

BackgroundSmall for gestational age (SGA) poses a significant concern for newborns, being linked to neonatal complications and potential metabolic disorders in adulthood, especially when born to mothers with gestational diabetes...

The Collision of Global Scripts with Local Constraints: Education as a Risk Factor for Unintended Pregnancy

Extensive sociological research concludes that education informs people’s desires for their lives and plays an instrumental role in facilitating the fulfillment of those desires. In this article, we ask if societal barriers can leave the most educated to desire outcomes that are unattainable and thus paradoxically place them at highest risk of unwanted outcomes. We answer this question by analyzing societal variation in the potential for education to facilitate women achieving their lower fertility desires: Are there fertility contexts wherein educated women’s lower fertility desires are distinctly unattainable? Multilevel models analyzing Demographic and Health Survey Program data on women from 50 low- and middle-income countries emphasize the collision of global scripts with local constraints: In low contraceptive contexts, education is associated with higher risk of unintended pregnancy. The results clarify that the potential for education to facilitate the achievement of desires is fraught with contingencies.

Conservative Management of Ectopic Pregnancy Following Depot Medroxyprogesterone Acetate Injection: A Case Report

Objectives: Ectopic pregnancy is the most common cause of maternal mortality in the first trimester of pregnancy. The use of progesterone-containing contraceptives is a risk factor for ectopic pregnancy. This study reports a rare case of ectopic pregnancy following a depot medroxyprogesterone acetate (DMPA) injection that was managed conservatively. Case Presentation: A 36-year-old woman (gravida 2) was referred to the Gynecology Clinic of the Persian Gulf Hospital, Bandar Abbas, Iran with a history of amenorrhea, vague pelvic pain, and no past medical history, except for DMPA injection, three months before the symptoms. Ectopic pregnancy was determined based on ultrasonography and beta-human chorionic gonadotropin (BHCG) evaluation. The patient was managed conservatively with serial ultrasonography and BHCG titration due to normal laboratory tests, stable clinical status, and a decline in BHCG titration. Conclusion: Amenorrhea and pelvic pain in all women of childbearing age should be considered an alarming sign of ectopic pregnancy. In case of stable hemodynamic status, the patient can be conservatively managed with serial trans-vaginal ultrasonography and evaluation of serum BHCG till the resolution of symptoms.

Comparison of early and fully expanded blastocysts on pregnancy and birth outcomes in patients with fresh IVF/ICSI cycles: A retrospective cohort study.

To investigate the effect of the early blastocyst on pregnancy and birth outcomes in patients in vitro fertilization/(early rescue) intracytoplasmic sperm injection-embryo transfer [IVF/(early rescue)ICSI-ET] cycles. In this retrospective cohort study, 289 patients with single-blastocyst transfer within IVF/(early rescue)ICSI-ET treatment cycle were included and divided into the early (n = 48, Gardner stage = 1 or 2) and the fully expanded blastocyst (n = 241, Gardner stage ≥ 3) groups. The differences in pregnancy and birth outcomes between the two groups were compared. There was no significant differences between the two groups in baseline indicators, including demographic characteristics and clinical treatment (P> 0.05).The clinical outcomes indicators in the early and the fully expanded blastocyst groups were compared, including the number of transferable embryos on the third day (D3)5.0 (4.0, 6.8) vs. 6.0 (5.0, 8.0) (P = 0.001), the number of remaining embryos frozen per cycle 1.0 (0.3, 2.0) vs. 3.0 (2.0, 5.0) (P<0.001); the number of cycles of unfrozen embryos 13/48 (27.1%) vs. 12/241 (5.0%) (P<0.001); the pregnancy outcome including the clinical pregnancy rate (CPR) 20/48 (41.7%) vs. 129/241 (53.5%) (P>0.05); the live birth rate (LBR)15/48 (31.3%) vs.106/241 (44.0%) (P>0.05). There were no significant differences in birth outcomes, such as gestational week of labor, mode of delivery, neonatal birth weight, height, Apgar score, sex ratio, and birth defects between the two groups (P>0.05).Multivariate binary logistic regression showed the same result, i.e., early blastocyst transfer in fresh cycle was not a risk factor for clinical pregnancy (OR = 0.516, 95% CI = 0.260-1.022) and live birth (OR = 0.521, 95% CI = 0.252-1.079). Compared with the fully expanded blastocyst group, the CPR and LBR in the early blastocyst group of the fresh transfer cycles were relatively ideal, and there were no significant differences in birth outcomes and neonatal status between the two groups.

Effects of prenatal stress on infant motor development

Introduction. The study aimed to investigate the correlation between prenatal maternal stress (PMS) experienced by women during pregnancy and perinatal risk factors and infant motor development, as assessed by the Alberta Infant Motor Scale (AIMS). Aim of the study It was hypothesised that infants born to mothers who experienced PMS have lower levels of motor development during their first year of life compared to infants of mothers who did not experience PMS. Material and methodology. The test was conducted on 171 women and their 179 children. The subjects were divided into two groups: 1) mothers who experienced PMS and 2) mothers who did not experience PMS. The same key was applied to divide the study infants into two subgroups: 1) infants of women experiencing PMS and 2) infants of women not experiencing PMS. Each infant was assessed using the standardised AIMS tool. Results. The study results suggest that infants of mothers experiencing PMS score lower on neurodevelopmental assessments, persisting at least 12 months after birth, than infants of mothers not experiencing PMS. Moreover, a correlation was demonstrated between stress during pregnancy and factors such as gestational age, mode of delivery, birth weight, and Apgar scores. Conclusions. Stress experienced by mothers during pregnancy can affect motor development in infancy. Also, perinatal factors such as the week and type of labour, birth weight, and Apgar score should not be underestimated.

Number of embryos transferred could possibly be associated with angular pregnancy in invitro fertilization-embryo transfer.

The probability of embryo implantation in an abnormal location is significantly higher in assisted reproductive technology (ART) than in natural pregnancies. Angular pregnancy is an eccentric intrauterine pregnancy with embryo implantation in the lateral superior angle of the uterine cavity. Cycle-level factors associated with angular pregnancy in patients conceived with ART needed to be explored. A total of 11 336 clinical pregnancies cycles were included. Angular pregnancy rate was compared among groups according to the type of embryos transferred. Among them, 53 cases of angular pregnancy and 159 cases of normal intrauterine pregnancy were screened out using propensity score matching. Risk factors of angular pregnancy were explored. The angular pregnancy rate was 0.31% (14/4572) in the day 5 blastocyst transfer group, 0.58% (39/6764) in non-day 5 embryo transfer group, with 0.55% (29/5280) in day 3 embryo transfer and 0.67% (10/1484) in the day 6 blastocyst group, respectively. A multifactor regression analysis was performed and indicated that the number of embryos transferred was significantly associated with angular pregnancy (P = 0.031, OR, 2.23, 95% CI: 1.09-4.68). Multiple embryo transfer could possibly be associated with an increased incidence of angular pregnancy in patients conceived with ART.

Pseudogestational Sac Delaying Diagnosis of Ectopic Pregnancy: A Case Report

BackgroundDiagnosis of ectopic pregnancy can be complicated by nonspecific laboratory and radiographic findings. The multiple alternative diagnoses must be weighed against each other based on the entire clinical presentation. Case ReportWe present a case of a 20-year-old woman who arrived to the Emergency Department (ED) with abdominal pain and ended up being transferred for an Obstetrics evaluation of a possible heterotopic pregnancy. Her radiology-performed ultrasound had revealed an “intrauterine gestational sac” along with an adnexal mass near the right ovary. The patient was not undergoing assisted-reproductive fertilization, nor did she have meaningful risk factors for heterotopic pregnancy. The patient was managed expectantly over the ensuing week to see whether the intrauterine fluid was a true gestational sac. After multiple repeat ED visits, the diagnosis of ectopic pregnancy was made. Ultimately, the patient elected for surgical management of her ectopic pregnancy. Why Should an Emergency Physician Be Aware of This?This case offers a reminder of the subtleties of radiographic identification of intrauterine pregnancies and the ever-present need to “clinically correlate.”

Assessment of Knowledge Regarding Postnatal Care among Men in Selected Rural Areas of Himachal Pradesh

Background: WHO defined health as the state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity, but it includes ability to lead socially and economically productive life.1 Being a man or women has a significant impact on health, as a result of both biological as well as gender related differences. This study assesses the knowledge about the antenatal care among married and unmarried men of 18-35 years age in selected rural areas of Himachal Pradesh. Methods: The study was an unmatched case and control design where married men were considered as a case and unmarried men as comparator group. This study was a part of large study for which sample size of 268 men in each group was calculated assuming prevalence of female contraceptives 70% in unmarried men and 85% in married men. This was carried out by cluster-based sampling in villages of Nagrota Bagwan and Shahpur health blocks of DRPGMC Tanda at Kangra. Results: The 93.3% participants among case group are aware of anaemia in pregnancy while only 64.9% among control group are aware of anaemia in pregnancy. The knowledge about all three causes of anaemia was statistically more in case group (61.9%) as compared to control group (38.8%). Assessment about high-risk pregnancy, about 72.4% participants among case group were aware about the risk factors in pregnancy as compared to 43.3% in control group with statistically significant differences (P=0.000). All the causes of high-risk pregnancy were reported by the participants of case group (44.0% vs 29.9%) with statistically significant differences. Conclusions: Married men had significantly more knowledge about various components of antenatal care. The awareness approach for unmarried men needs to be designed regarding antenatal care.

Using electronic medical records to understand the impact of SARS-CoV-2 lockdown measures on maternal and neonatal outcomes in Kampala, Uganda.

Kawempe National Referral Hospital (KNRH) is a tertiary facility with over 21,000 pregnant or postpartum women admitted annually. The hospital, located in Kampala, Uganda, uses an Electronic Medical Records (EMR) system to capture patient data. Used since 2017, this readily available electronic health record (EHR) has the benefit of informing real-time clinical care, especially during pandemics such as COVID-19. We investigated the use of EHR to assess risk factors for adverse pregnancy and infant outcomes that can be incorporated into a data visualization dashboard for real time decision making during pandemics. This study analysed data from the UgandaEMR collected at pre-, during- and post-lockdown timepoints of the COVID-19 pandemic to determine its use in monitoring risk factors for adverse pregnancy and neonatal outcomes. Logistic regression models were used to identify the risk factors for adverse pregnancy and maternal outcomes including prematurity, obstetric complications, still births and neonatal deaths. Pearson chi-square test was used for pair-wise comparison of the outcomes at the various stages of the pandemic. Data analysis was performed in R, within the International COVID-19 Data Alliance (ICODA) workbench. A visualisation dashboard was developed based on the risk factors, to support decision making and improved healthcare delivery. Comparison of pre-and post-lockdown variables showed an increased risk of pre-term birth (adjusted Odds Ratio (aOR = 1.67, 95% confidence interval (CI) 1.38-2.01)); obstetric complications (aOR = 2.77, 95% CI: 2.53-3.03); immediate neonatal death (aOR = 3.89, 95% CI 2.65-5.72) and Caesarean section (aOR = 1.22, 95% CI 1.11-1.34). The significant risk factors for adverse outcomes were younger maternal age and gestational age <32weeks at labour. This study demonstrates the feasibility of using EHR to identify and monitor at-risk subpopulation groups accessing health services in real time. This information is critical for the development of timely and appropriate interventions in outbreaks and pandemic situations.

Asuhan Kebidanan Komprehensif Pada Ny N Umur 22 Tahun Dengan Kekurangan Energi Kronik Di Puskesmas Bumiayu Tahun 2023

Background: KEK is one of the risk factors for pregnancy causes complications and maternal death. The global maternal mortality rate due to CED is 37%, maternal deaths in Central Java Province in 2020 were 530 cases. The maternal mortality rate in Brebes district is 62 cases. At the Bumiayu Health Center, the maternal mortality rate in 2020 was 2 cases. The aim is to be able to carry out Comprehensive Midwifery Care for Mrs N aged 22 years with Chronic Energy Deficiency at the Bumiayu Community Health Center using Varney's seven-step midwifery management and SOAP Research Method: this research is a qualitative descriptive research with a case study approach. The results: of Comprehensive Midwifery Care for Mrs N were that during pregnancy KEK was found. Delivery was normal and the newborn was found to be underweight. In neonates, boils were found on the legs and the baby's body temperature was high, then appropriate management was carried out so that the problem was resolved. During the postpartum period, the stitched wound was found to be still wet, then ointment was given to solve the problem. Mother uses birth control implant. Conclusion: care has been carried out in accordance with midwifery service standards.

Prophylactic Single-Dose Systemic Methotrexate Therapy for High-Risk Group in Persistent Ectopic Pregnancy After Laparoscopic Conservative Surgery of Tubal Pregnancy

Backgroud: to evaluate whether the incidence of persistent ectopic pregnancy after laparoscopic conservative surgery can be reduced or prevented by prophylactic single-dose systemic methotrexate (MTX) in high-risk group. Methods: Women who underwent laparoscopic conservative surgery for treatment of unruptured ectopic pregnancy, who agreed to participate in the study and who had risk factors for persistent ectopic pregnancy (n = 112) were randomly assigned to the prophylaxis or control group. In the prophylaxis group (n = 72), patients received a single dose of MTX, 1.0mg/kg intramuscularly, within 24 hours postoperatively. No treatment was used in the control group (n = 40). Both groups were followed with serial serum b-hCG titers; titers were measured on the frist postoperative day, then every 72 hours until levels were lower than 5mIU/ml. Results: Four women had persistent ectopic pregnancy, no in the prophylaxis group (0%) and four among the controls (10%); this difference was statistically significant (P &lt; 0.01). One women (1.4%) reported mild side effects after MTX, but these resolved spontaneously. Conclusions: The incidence of persistent ectopic pregnancy was significantly reduced after a single prophylactic dose of systemic MTX administered postoperatively in high-risk group. This regimen is safe and can be used to decrease the extent of postoperative monitoring after conservative treatment of unruptured ectopic pregnancy.

#132 : Outcomes and Related Risk Factors of Heterotopic Pregnancy in IVF-ET Cycles

Background and Aims: In vitro fertilization-embryo transfer (IVF-ET) has demonstrated significant success in treating infertility, but it can also introduce complications and risks such as heterotopic pregnancy (HP), which can lead to ectopic pregnancy rupture and bleeding, potentially endangering the patient’s life and fertility. This study aims to investigate the outcomes and associated risk factors of HP following IVF-ET, providing clinical insights for HP treatment. Methods: A retrospective analysis was conducted on the clinical data, treatment, and pregnancy outcomes of patients with HP after IVF-ET admitted to First Hospital of Lanzhou University from Jan. 2012 to Dec. 2022. Statistically significant risk factors were identified and subjected to logistic regression analysis. Results: Our data revealed a HP incidence of 1.27%. Among the 66 patients with HP, 5 underwent conservative treatment (7.58%, 5/66) with a live birth rate of 25.00% (1/5). Laparoscopic surgery was performed on 61 cases (92.42%, 61/66), with a live birth rate of 77.05% (47/61). Among patients receiving laparoscopic surgery, 49.18% (30/61) had a history of pelvic surgery, 39.34% (24/61) underwent a fresh IVF cycle, and 60.66% (37/61) had a freeze-thaw cycle. The live birth rate was 83.67% (41/49) for those with a visible fetal germ and 85.37% (35/41) for those with a visible fetal heartbeat prior to surgery. Further logistic regression analysis revealed that the average diameter of the intrauterine gestational sac prior to laparoscopic surgery, the absence of a fetal germ and fetal heartbeat within the intrauterine gestational sac, and an extended duration of laparoscopic surgery were risk factors affecting pregnancy outcomes (P&lt;0.05). Conclusion: The incidence of HP in IVF-ET is much higher than in natural conception. Laparoscopic surgery is an effective treatment for HP, which does not seem to impact the ongoing pregnancy and live birth rates of the intrauterine gestational sac. However, the patient’s pregnancy outcome can be influenced by several factors, such as the average diameter and development of the intrauterine gestational sac prior to surgery, as well as the duration of the surgery.