Breastfeeding following in vitro fertilisation in Switzerland-Does mode of conception affect breastfeeding behaviour?

AIM: Breastfeeding has numerous advantages. Our aim was to investigate whether breastfeeding initiation and duration in women with pregnancies conceived through in vitro fertilisation differ from spontaneously conceived pregnancies. METHODS: This is a comparative cross-sectional study about breastfeeding behaviour performed at the Bern University Hospital including mothers of singletons conceived by in vitro fertilisation (n = 198) with or without gonadotropin stimulation between 2010 and 2016 (in vitro fertilisation group). They were compared to a population-based control group (n = 1421) of a randomly selected sample of mothers in Switzerland who delivered in 2014. RESULTS: A total of 1619 women were included in this analysis. Breastfeeding initiation rates were high, similar between the in vitro fertilisation group (93.4%) and the control group (94.8%). No increased risk of stopping breastfeeding earlier after in vitro fertilisation treatment compared to the control group could be found over the observational period of 12 months (HR = 1.00, 95% CI 0.83-1.20, P = .984). There was no difference in breastfeeding initiation or duration after gonadotropin-stimulated vs unstimulated in vitro fertilisation. CONCLUSION: In Switzerland, in vitro fertilisation treatments were not associated with earlier breastfeeding cessation. This result is reassuring for mothers undergoing in vitro fertilisation.

A Retrospective before and after Assessment of Multidisciplinary Management for Postpartum Hemorrhage.

Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality. While PPH treatment guidelines exist, data on their effect on reduction in red blood cell (RBC) transfusions and use of hemostatic products are scarce. Continuous evaluation of PPH management is important to assess potential pitfalls and incorporate new treatment options. We retrospectively compared PPH management and administration of RBC and hemostatic products before and after international guideline implementation. The primary endpoint was RBC administration for PPH. Secondary endpoints were hemoglobin trigger for RBC administration, administration of hemostatic products and surgical therapies. In total 235 patients had a PPH, 59 in 2011 and 176 in 2018. In 2018, fewer patients received RBC within 24 h (2018: 10% vs. 2011: 32%, p < 0.001) and 24 h after delivery (2018: 4.5% vs. 2011: 37%, p < 0.001). The number of RBC units transfused per case was significantly lower in 2018 (two vs. four units in 2011, p = 0.013). A significantly reduced transfusion of fresh frozen plasma and platelets was observed in 2018 (p < 0.001 and p = 0.002, respectively). In 2011, additional surgeries for PPH in both the acute and subacute phase were performed more frequently. Local implementation of multidisciplinary PPH guidelines is feasible and was associated with a significant reduction in transfused blood products.