Hum. Reprod. Advance Access published online on August 21, 2009
Human Reproduction, doi:10.1093/humrep/dep301
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Assisted fertilization and breech delivery: risks and obstetric management
1 Department of Obstetrics and Gynaecology, IVF Unit, St Olav's University Hospital, Trondheim NO-7006, Trondheim, Norway 2 Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway 3 Medical Birth Registry of Norway, Bergen, Norway 4 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
5 Correspondence address. Tel: +47 72593808; E-mail: libero{at}ntnu.no
BACKGROUND: Previous studies have suggested that assisted reproduction technology (ART) is associated with increased risk of breech presentation. We investigated whether factors that tend to differ between ART and spontaneously conceived pregnancies may explain the higher risk of breech deliveries associated with ART.
MATERIAL AND METHODS: In this population-based cohort study, we included 1 209 151 singleton pregnancies reported to the Medical Birth Registry of Norway between 1984 and 2006 and compared the risk of breech presentation in 8229 ART pregnancies with that in spontaneously conceived pregnancies. Risk ratios (RR), adjusted for maternal age, parity, gestational length and year of birth, were estimated using binominal regression, and we describe differences and time trends in obstetric management for breech and cephalic presentations after ART compared with management of spontaneously conceived pregnancies.
RESULTS: Breech presentation occurred nearly 50% more often in ART singleton pregnancies than in spontaneously conceived singletons [crude RR: 1.48, 95% confidence interval (CI): 1.34–1.64], but after adjustment for potentially confounding factors, the difference was fully attenuated (RR: 0.97, 95% CI: 0.88–1.07). The most important contributors to the attenuation were parity and length of gestation. In general, Caesarean sections and induced deliveries were more likely in ART pregnancies, but over the study period, the proportion of Caesarean sections in ART pregnancies gradually approached that of spontaneously conceived pregnancies.
CONCLUSION: Increased risk of breech presentation in pregnancies after ART is mediated by lower parity and shorter gestational length. In general, the obstetric management of women with ART pregnancies is gradually approaching the ordinary surveillance of pregnant women.
Key words: assisted reproduction technology/breech presentation/singletons/Caesarean section/population study
Submitted on May 14, 2009; resubmitted on July 9, 2009; accepted on July 10, 2009.