Mode of conception does not affect fetal or placental growth parameters or ratios in early gestation or at delivery.

PURPOSE: Ratio of fetal weight to placenta size varies by mode of conception (fertility treatments utilized) in animals. Our objective was to assess whether fertility treatments also affect these ratios in humans. METHODS: In this retrospective study, we assessed two cohorts: (a) early gestation cohort, women with singleton pregnancies who underwent first trimester vaginal ultrasound and (b) delivered cohort, women who delivered a live-born, singleton infant with placenta disposition to pathology. Crown rump length (CRL) and estimated placental volume (EPV) were calculated from first trimester ultrasound images using a validated computation. Infant birth weight (BW), pregnancy data, placental weight (PW), and placental histopathology were collected. Fetal growth-to-placental weight ratios (CRL/EPV; BW/PW) and placentas were compared by mode of conception. Linear regression was used to adjust for confounding variables. RESULTS: Two thousand one hundred seventy patients were included in the early gestation cohort and 1443 in the delivered cohort. Of the early gestation cohort (a), 85.4% were spontaneous conceptions, 5.9% Non-IVF Fertility (NIFT), and 8.7% IVF. In the delivered cohort (b), 92.4% were spontaneous, 2.1% NIFT, and 80 5.5% IVF. There were no significant differences between fetal growth-to-placental weight parameters, ratios, and neonatal birth measurements based on mode of conception. Placenta accreta was significantly higher in the patients receiving fertility treatments (1.2 versus 3.6%, p < 0.05). CONCLUSIONS: Mode of conception does not appear to influence fetal growth-to-placental weight ratios throughout gestation. In addition, findings in animal models may not always translate into human studies of infertility treatment outcomes.

Quality Improvement: Changing Patterns of Antibiotic Prophylaxis for Surgical Abortion.

OBJECTIVE: Postprocedure infection complicates nearly 5% of abortions. Multiple organizations endorse prophylactic antibiotics to reduce infection risk with surgical abortion, but the adherence rate remains unknown for women who obtain antibiotics at a pharmacy and take them at home before their procedure. Our objective was to evaluate the effect of quality improvement interventions on antibiotic utilization and preoperative documentation for women undergoing surgical abortion at our academic institution. METHODS: An initial quality evaluation of antibiotic utilization by women who had abortions in our operating room between April 2012 and June 2013 revealed suboptimal antibiotic adherence and poor physician documentation. To address these issues, we recommended patients to fill prescriptions at the pharmacy located in the same building as our clinic and created a standard preoperative template for the medical record. We reexamined outcomes for women having abortions from April 2014 to June 2015. RESULTS: Antibiotic adherence increased from 81% to 90% (p < .001). The proportion of patients not receiving antibiotics decreased from 2.4% to 0.5% (p = .01). Adherence documentation rates improved from 69% to 99% (p < .001). CONCLUSIONS: Using an easily accessible pharmacy and a standard preoperative template improves utilization of prophylactic antibiotics for patients undergoing abortions in the operating room.