prenatal evaluation of high risk pregnancies following invitro -fertilization:

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Prenatal Evaluation of High Risk Pregnancies following Invitro -Fertilization: “Reduce Mother and Fetus Mortality Rates!”. Irani Sh. * ( B.Sc.&PHD ), Javam M. ( B.Sc ), Ahmadi F. (MD ) - PowerPoint PPT Presentation

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Prenatal Evaluation of High Risk Pregnancies following Invitro-Fertilization: Reduce Mother and Fetus Mortality Rates!Irani Sh.* (B.Sc.&PHD), Javam M. (B.Sc), Ahmadi F. (MD)

Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran

Whats the issue ?The use of assisted-reproduction technologies has increased over the past decade!

Pregnancies following IVF are associated with higher risk of obstetric morbidities and perinatal mortality and several studies have demonstrated that the rate of prenatal complications is significantly more frequent in IVF-conceived pregnancies compared to spontaneous pregnancies.ResultsPopulationCountryAuthor (year)Ante-partum hemorrhage congenital anomalies hypertensive disorders of pregnancy (HTN)preterm rupture of membranes (PROM)cesarean section (CS)low birth weight (LBW)perinatal mortality (P.M)preterm delivery (PTD)gestational diabetes small for gestational ageMetha analysis(20 Studies)UKShilpi pandy2012Multiple pregnancy P.MPTDLBWCSplacenta previa (P.P)congenital abnormalitiesReductionReview articlecanadaVicoriam(2006)Overall failure of pregnancy: 21,7% Twins: (%17/1)Death after positive FHR : 12,2%Twins: 7,3%1597single 1200Twin 397belgiumPhilippe Tummers (2003)CSPTDLess average birth weight283croatiaDu valtka (2005)Bleeding ovarian torsion preeclampsia placental abruptionPROM P.P-swedenBengt kallen (1981- 2001)Single : HTN / bleeding / maternal complication Twins : CS / bleeding / preterm labor / LBWSingle : 322Twin : 78GermanyOdsenkuhn.R(1991-1996)

Thus, a proper prenatal evaluation is required in this group to protect mother and fetus health!

Sonographic examination during pregnancy is a helping method to detect pregnancy complications and to organize a proper prenatal care for IVF-conceived women.

We provide a clinical instruction for sonographic assessment of pregnancies following IVF and management of patients based on reports:

1st trimester :Goals of first ultrasound scan of IVF-resulted pregnancies:

To assure a normal intrauterine pregnancy!

To rule out emergency conditions that are a threat to mothers health: * Ectopic or Heterotopic Pregnancy is shown to be 5-10 times more prevalent than general population! * Molar pregnancy & threatened abortion are also more frequent in this group

To establish gestational age accurately and to confirm fetus viability

To determine the number of fetuses and chorionicity-amnionicity in multiple pregnancies based on: the number of gestational sacs, amnions, and yolk sacs

D-D twins

(DZ)M-D twins

(MZ)M-M twins

(MZ)

1st trimester complications:1. Bleedingwith IUP:

Failed pregnancy (missed AB FHR -) Hemorrhage Partial mole (less common) An embryonicHeterotopic pregnancy (rare)Interestitial / cervical EP (rare)Twin demise without IUP:

Complete AbortionVery early pregnancy Retained product of P.Tubal ectopic Complete hydatyform Mole (less common)Abdominal ectopic (rare)

2. Pain:Hemorrhagic cyst Corpus Luteum cyst EPOHSSAdnexal torsion Appendicitis (less common)

3. Discrepancy between GA and ET-date:GS without fetal pole

Fetal pole without FHR

Fetal pole with FHR

Multiple fetuses

blighted ovum or not ? (GS diameter 20mm?)

monitor sonography recommended (based on previous exams)

follow-up within weeks 11-14

follow-up studies based on chorionicity

1st trimester Anomaly ScreeningSome embriologists believe that the risk of fetal anomalies in IVF-resulted embryos is a bit higher!

Thus, a careful examination needs to be done for anomaly screening in this group.

First anomaly scan contains Nuchal Translucency measurement and look for structural abnormalities within 11th-14th weeks.

Further investigations are recommended in case of increased risk.

First TrimesterAnomaly Screening

2nd & 3rd trimesters :Second and third trimester have are vital periods of fetal growth.

There are several complications which have adverse affects on this event.

Sonography is helpful for early detection of risks for most of these complications such as vaginal bleeding, IUGR, preterm birth, etc.

1. Cervical Insufficiency:A prevalent cause of preterm birth among these women

Early diagnosis & decision for cerclage placement can reduce PTB rate.

Screening method: - Serial cervical length measurement by means of TAS or TVS (preferred) - At least twice during 2nd trimester (before 20th week)

2. Bleeding:Common reasons:

Placenta previa Marginal sinus previa Placenta accreta spectrum

Less common:

Succenturiate lobe Placenta accreta Placenta abruptionCesarean section rupture

Marginal previa

3. PROM & oligohydroamnios:Maximum Vertical pocket