Complications of pregnancy in infertile couples: routine treatment versus assisted reproduction
Article Abstract:
New reproductive technologies have made it easier for once-infertile patients to conceive. Methods of assisted reproduction such as in vitro fertilization and embryo transfer (IVF-ET), previously reserved for women with a history of pelvic disease or those who had surgical removal of their fallopian tubes, are now being used to treat all types of infertility. Although the success of such procedures in bringing about conception has been well established, less is known of the effects of in vitro techniques on the outcomes of such assisted pregnancies. The incidence of spontaneous abortion (miscarriage) following IVF-ET has been compared with the rates found in the general population, an inadequate comparison group. This study examines the outcome of pregnancies conceived by assisted reproduction (90 pregnancies) and of 86 pregnancies conceived following routine treatment for infertility. Routine fertility treatments included a hysterosalpingogram (injecting a contrast material to assess fallopian tubes openings), postcoital test (test assessing adequacy of sperm motility in vaginal mucus after intercourse), endometrial biopsy (sampling of the lining of the uterus), laparoscopy (visual inspection of the reproductive structures), hysteroscopy (visual inspection of the inside of the uterus) and sperm analysis. The incidence of pregnancy complications was compared between the infertile pregnancies and pregnancies conceived by normal fertile couples. There were 81 single pregnancies and nine multiple pregnancies in the assisted reproduction group, and 84 single and two multiple pregnancies in the routinely treated group. The pregnancy was lost before the 24th week of pregnancy in 29 out of 90 (32 percent) pregnancies conceived by assisted reproduction compared with 18 out of 86 (21 percent) of the pregnancies conceived by routine methods. The pregnancy complication rate for single-fetus pregnancies was similar among pregnancies achieved in fertile and infertile couples. Infants born to mothers conceived by routine methods were smaller and were more often premature than infants from the other two groups. This may be a statistical aberration due to the inclusion of one set of quintuplets and one set of twins in this group. It is concluded that there is no added risk for complication of pregnancies when assisted reproduction and routine methods are used to achieve pregnancy in infertile couples. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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The epidemiology of group B streptococcal colonization in pregnancy
Article Abstract:
In the early 1970s, group B streptococcus was found to be an important bacterial cause of disease in pregnancy. Early studies on the effects on pregnancy and its outcome from infection with this agent were incomplete. This study further examined infection with this bacterium during pregnancy in a larger population than has previously been reported. The study period was from November 1, 1984 to June 30, 1987 and included data from 7,742 women from various parts of the United States. The women were tested for group B streptococcus colonization in the vaginal and cervical areas. Positive cultures were obtained from 18.6 percent of the women, with the highest prevalence (26.4 percent) among women in New York City, and the lowest prevalence (9.2 percent) in Texas. By race, positive cultures were found in 21.2 percent of blacks, 20.9 percent of Hispanics, and 13.7 percent of whites. Risk was also greater in older women, women not living with their partner, women with fewer than nine years of education, and women with very high numbers of sexual partners within the previous year. Smokers had a lower prevalence of infection. The overall results did show certain risk factors existed for infection with group B streptococcus during pregnancy, but no particular group of women could be isolated as having a very high risk for infection. Selective screening for which pregnant women should be tested further for this infection does not appear useful. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1991
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Vaginal pH: a marker of preterm premature rupture of membranes
Article Abstract:
There is a high rate of mortality and illness among infants born early or of low birth weight. Early rupture of the membranes surrounding the fetus, which can initiate the onset of labor, contributes to early delivery of low birth weight infants. Although maternal smoking, low socioeconomic status and increased bacterial growth in the vagina have been associated with premature rupture of membranes (PROM), it is difficult to identify women at risk for the condition. The degree of acidity (pH balance) in the vagina can be altered by abnormal bacterial growth. To see if measuring the pH of the vagina can be useful in predicting PROM, 115 women at high risk for a low birth weight births were studied. Twenty-four percent out of 115 patients experienced PROM. PROM occurred in 11 percent of the patients whose pH values were always less than 4.5 and 47 percent of the patients with pH values that were always above 4.5. Women having pH determinants above 4.5 were three times more likely to experience PROM. Since there are no good methods to identify women at risk, tests that identify even a small number of women at risk are beneficial. Therefore, vaginal pH may be useful in predicting a pregnant woman's risk for PROM. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1989
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