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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Corticosteroids for Preterm Babies

Assumption: A dose of corticosteroids given to women at high risk of preterm labor helps babies’ lungs develop and prevents problems.

TRUE
No negative side effects have been documented, but fewer babies are dying of breathing problems when moms are given an injection of corticosteroids prior to birth.  The corticosteroids help the lungs develop more quickly, preventing respiratory distress.

http://www2.cochrane.org/reviews/en/ab004454.html

My Views:
Since the lungs appear to be the last organs to fully develop, I am so glad women have options that will help their babies breathe if the babies are born early (prior to 37 weeks).  These studies indicated no adverse effects to mom or baby, which is comforting as well.  However, the studies examined in this report examined the effects of ONE does of the steriods.  Multiple doses *may* have effects and should be used sparingly.

Prescribed Bed Rest

Assumption: Bed Rest will prevent premature birth.

FALSE
Although more studies are needed, current findings show no evidence that bed rest prevents premature birth.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003581.pub2/abstract

My Views:  My suspicion is that bed rest per se is not going to prevent premature birth.  However, I wonder if stress might contribute to the problem.  Some women may be working too hard and therefore bed rest would be helpful for getting them to slow down.  Other women might be *more* stressed if they are limited to the bed.  Finding a situation that is right for the woman involved should be the main goal of the physician when deciding to prescribe bed rest or not.

PROM: Home or Hospital

Assumption: Once membranes have ruptured, women are safer in the hospital than at home.

FALSE
Yet another topic in which there is not enough information to make a full conclusion.  These studies are interesting, but need more data!

The studies examined here measured outcomes when waters broke preterm. The studies covered 116 women, so the pool is too small to make definite conclusions, but of those women, people who STAYED AT HOME after the rupture were ultimately more satisfied with the experience and had no worse outcomes for mom or baby.  Women who went to the hospital were also more likely to have a cesarean birth.

http://www2.cochrane.org/reviews/en/ab008053.html

My Views:
My personal experience includes water breaking at 36 weeks and waiting 3 days for labor to begin.  I was not uncomfortable and was careful to protect against infection.  I was certainly much more comfortable at home with my family than I would have been in the hospital and am grateful that I was “allowed” to be at home during this time.  All worked out fine and Baby N got an extra 3 days of gestation. 🙂  But I’m just one case…