IVF and Perinatal Outcomes

Assumption: An IVF pregnancy is just the same as a naturally occurring pregnancy.

FALSEIn this study from 2004, researchers found that low birthweight, early preterm delivery, spontaneous preterm delivery, placenta previa, gestational diabetes, preeclampsia, and neonatal intensive care admission were statistically higher in women who had used IVF to achieve pregnancy.  The conclusions recommended that doctors take this into consideration when recommending elective preterm labor induction or cesarean.

http://www.ncbi.nlm.nih.gov/pubmed/14990421

 

My Views:I am in no way against IVF and in fact some of my very favorite people started life this way! 🙂  However, I recently got a question from a student about whether she should actively petition her doctor to induce because her baby was conceived through IVF and I thought this topic was an interesting one to look into.  My research found that while morbidity was more prevalent in IVF babies, this was usually associated with other factors, including mother’s health and multiple pregnancies.  This study actually indicates that induction, particularly induction before the due date, is contraindicated and should be avoided because of the prevalence of low birthweight babies and NICU admission.

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Breaking Waters

Assumption: Breaking the bag of waters (amniotomy) will shorten labor by getting things moving.

FALSE
This review of studies shows no difference in the length of the first stage of labor (all labor prior to pushing) between women who had amniotomy and those who allowed their water to break on its own.

http://summaries.cochrane.org/CD006167/amniotomy-for-shortening-spontaneous-labour

 

My Views:
Breaking a woman’s bag of waters prematurely does carry risks, the scariest of which is a prolapsed cord.  Since these studies show little benefit in terms of moving labor along, it is definitely worth a conversation with your caregiver before deciding on this procedure.  My own personal story is that I did opt for amniotomy in my fourth pregnancy and I truly believe it was the right decision in that circumstance.  (If you want the whole story, I’m happy to share.  Shoot me an email! sabirth@gmail.com)  This experience showed me that the procedure can be valuable, but it is not something that should be routine and women should know that evidence does not show that it will speed labor as many hope it will!

Cytotec Ripening/ Induction

Assumption: Cytotec is a benign drug used to help the cervix ripen before Pitocin is used to induce labor.

FALSE
Although Cytotec is often used to ripen the cervix, there are dangers associated with this drug that was developed to treat ulcers.  Compared to other ripening agents, Cytotec (misoprostol) does have advantages.  It is inexpensive, easy to store, and does cause uterine contractions that often achieve labor within 24 hours.  Unfortunately, uterine hyperstimulation was increased and meconium staining were more frequent.  According to the authors, “The apparent increase in uterine hyperstimulation is of concern.”  They also note that there were not enough cases studied to rule out “the possibility of rare but serious adverse events, particularly uterine rupture, which has been reported anecdotally following misoprostol use in women with and without previous caesarean section.”  The authors of the study recommend further research and guidelines for the medical community in using this drug.

http://www.ncbi.nlm.nih.gov/pubmed/12535398

My Views:
Since there is a choice between Cytotec and other ripening agents (such as Cervidil and Prepidil), I see no reason to risk uterine hyperstimulation.  Unlike Pitocin, which is given continuously through an IV, Cytotec is administered in pill form and once it is in the woman’s system cannot be removed.  These facts send up red flags to me.  Further, the company that makes Cytotec recommends *against* its use with pregnant women and it is not FDA approved for the purpose of induction.  In my mind, all this adds up to waiting for more conclusive research on the safety of this drug.