[Impact of assisted reproduction on obstetrics and neonatology]. / Einfluss der assistierten Reproduktion auf Geburtshilfe und Neonatologie.

BACKGROUND: In industrialised countries, 1-4% of all children are born as a result of assisted reproductive therapies (ART), such as IVF and ICSI. Possible associations of these ARTs with obstetric and neonatal risk constellations are analysed critically in the context of this review. METHODS: A selective literature search was conducted to examine the influence of ART on obstetric and neonatal aspects. RESULTS: Multiple gestations, occurring more frequently after ART, are of special significance with regard to their associated risks. In comparison to spontaneous pregnancies, singleton gestations after ART are associated with higher rates of complications, such as preeclampsia, prematurity, low birth weight, foetal malformations and a higher rate of Caesarean sections. Although causal associations between extracorporeal fertilisation methods and health risks for mothers and infants in singleton pregnancies cannot be ruled out, these complications are rather attributed to the underlying causes of infertility than to the methods of assisted reproduction themselves. CONCLUSIONS: Pregnancies after ART are to be regarded as risk constellations with a need for closer surveillance during gestation - irrespective of the number of developing foetuses. Couples seeking advice about infertility should be informed in detail before the onset of ART.

[Prevention of complications in twin gestations and pregnancies after assisted reproduction]. / Risikoprävention bei Geminigraviditäten und Schwangerschaften nach assistierter Reproduktion.

BACKGROUND: Twin pregnancies and gestations after assisted reproductive therapy (ART) are of special obstetric significance with regard to their associated risks. However, little is known about preventive approaches specifically evaluated for these constellations. METHODS: A selective literature search was conducted to examine possible preventive approaches for complications such as hypertensive disorders, anaemia, gestational diabetes, prematurity, and others, seen significantly more often in twin gestations and pregnancies after ART. RESULTS: For both constellations, preventive approaches are not specifically evaluated for the majority of complications. For some preventive methods a possible detrimental effect cannot even be ruled out. CONCLUSIONS: The knowledge about specific preventive approaches against complications in twin pregnancies and gestations after ART is scarce. More prospective trials are urgently needed to assess the risks and benefits of prophylactic approaches for these risk constellations.

[Spontaneously conceived twins and twins after ART: are there any differences regarding direct financial costs of delivery]. / Gibt es einen Unterschied der direkten Entbindungskosten bei spontan eingetretener Zwillingsgravidität und Gemini nach Kinderwunschbehandlung?

BACKGROUND: Healthcare expenditures are rising steadily. There are no data on delivery expenses of twin pregnancies. This study aims to provide data on expenses of twin deliveries and to compare expenditures of deliveries after spontaneous conception with deliveries after infertility treatment. PATIENTS AND METHODS: Retrospective cohort-analysis on obstetrical data of twin deliveries at the Department of Obstetrics and Gynaecology of the University Hospital Schleswig-Holstein, Campus Luebeck between January 2000 and December 2008. A comparison of delivery expenses of spontaneous twin pregnancies and after infertility treatment. RESULTS: Patients delivering twins after infertility treatment stay 1.1 days longer at the hospital, are 2.5 years older and the number of previous pregnancies and deliveries are significantly lower compared to women after spontaneous conception of twins. In our setting fetal outcome (weeks of gestation, birthweight, APGAR, umbilical arterial pH, admission to neonatal intensive care unit etc.) and other maternal data (maternal height, maternal weight, length of surgery etc.) were not significantly different. The prolonged time spent in hospital leads to a 250 Euro higher expense per patient. DISCUSSION: Additional expenses of twin deliveries after assisted reproduction are due to a longer stay at the hospital. This prolonged stay of an average of 1.1 days was not obvious to medical reasons. Main delivery expenses for the substantial outcome-parameters are not significantly different between both groups.