Embargoed: 00.01 hrs London time Thursday 25 ... - Oxford Journals
Embargoed: 00.01 hrs London time Thursday 25 ... - Oxford Journals
Embargoed: 00.01 hrs London time Thursday 25 ... - Oxford Journals
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<strong>Embargoed</strong>: <strong>00.01</strong> <strong>hrs</strong> <strong>London</strong> <strong>time</strong> <strong>Thursday</strong> <strong>25</strong> May 2006<br />
New research links placenta praevia directly to assisted reproductive techniques<br />
Norwegian researchers have found the first evidence that techniques used in assisted<br />
reproduction (ART) may be directly linked to an increase in placenta praevia – a<br />
potentially dangerous condition in which the placenta covers, or partially covers the<br />
cervix, blocking the baby’s passage into the birth canal.<br />
A study published today (<strong>Thursday</strong> <strong>25</strong> May) in Human Reproduction 1 concluded that<br />
there was a six-fold higher risk of the condition in single-baby pregnancies conceived<br />
through ART compared with natural conception and a three-fold higher risk among<br />
mothers who had conceived both naturally and through ART.<br />
“What this means in absolute terms is that after adjusting for factors such as maternal<br />
age, which tends to be higher in ART pregnancies, the risk of placenta praevia rose from<br />
about three in 1,000 births to 16 in 1,000 births for ART pregnancies compared with the<br />
general population, and from about seven in 1,000 births to 20 in 1,000 births for those<br />
who had both assisted and natural conceptions,” said lead author Dr Liv Bente<br />
Romundstad, from the Department of Obstetrics and Gynaecology at St Olavs University<br />
Hospital in Trondheim.<br />
Placenta praevia, where the placenta attaches itself to lowest segment of the uterine wall<br />
and either blocks or partially blocks the cervix, is associated with serious and potentially<br />
life-threatening problems for mother and baby. These include haemorrhage in the<br />
mother, either in before or after the birth, and the need for caesarean section in the case<br />
of total placenta praevia. For the baby the risks include prematurity and perinatal<br />
problems.<br />
Some small studies have suggested in the past that placenta praevia is more common<br />
after ART, but the authors believe that the new research looking at over 845,300<br />
pregnancies in the Norwegian Medical Birth Registry between 1988 and 2002 is the most<br />
extensive in the world to examine links between placenta praevia and ART. Furthermore,<br />
it is the first to indicate that the increase in risk may be directly related to the reproductive<br />
techniques used.<br />
Dr Romundstad explained: “As well as comparing placenta praevia among women who<br />
had given birth only to babies conceived through IVF or ICSI 2 and the general population,<br />
we studied 1,349 women who had conceived spontaneously in one pregnancy and after<br />
assisted fertility in the other. Regardless of whether it was the first or second pregnancy<br />
that was conceived through ART we found a nearly three-fold higher risk of placenta<br />
praevia. This suggests that a substantial proportion of the extra risk may be attributable<br />
directly to factors relating to the reproduction technology.”<br />
The underlying mechanism causing the placenta praevia is not clear. One possibility<br />
could be the position that the embryo is placed in the uterus when it is transferred via a<br />
catheter through the cervix. The procedure may induce uterine contractions, possibly due<br />
to the release of prostaglandins after stimulation of the cervix, leading to more embryos<br />
implanting low-down in the uterus. In addition, because research has shown that<br />
transferring the embryo to a position low in the uterus may improve implantation rates,<br />
current practice tends to favour placing the embryo low down.
Their findings have so concerned the research team that they are calling for ART centres<br />
to monitor and record the distance of every transferred embryo from both the internal<br />
cervical entrance and the uterine fundus (the part of the uterus lying above the opening<br />
of the fallopian tubes).<br />
“We now routinely do this, but we need other centres worldwide to do this as well,“ said<br />
Dr Romundstad. “Although the risk of placenta praevia is considerably higher with ART it<br />
is still quite rare, which means it will probably take several thousand pregnancies to get<br />
sufficient data to be able to make any definite recommendations about clinical practice.”<br />
(ends)<br />
1<br />
Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison<br />
of ART and non-ART pregnancies in the same mother. Human Reproduction.<br />
http://www.oxfordjournals.org/eshre/press-release/freepdf/del153.pdf<br />
2<br />
I VF – in-vitro fertilisation. ICSI – intracytoplasmic sperm injection: process by which an<br />
ooctye is fertilised by injecting a single sperm into the ooctye.<br />
Notes:<br />
PDF version of this press release and full embargoed text of the paper with complete results can be<br />
found from 09:00<strong>hrs</strong> <strong>London</strong> <strong>time</strong> Tuesday 23 May at:<br />
http://www.oxfordjournals.org/eshre/press-release/may06.pdf or is available from Margaret Willson<br />
Human Reproduction is a monthly journal of the European Society of Human Reproduction and Embryology<br />
(ESHRE). Dr Helen Beard, Managing Editor. Tel: +44 (0)1954 212404.<br />
Email: beardh@humanreproduction.co.uk<br />
ESHRE’s website is: http://www.eshre.com<br />
Please acknowledge Human Reproduction as a source<br />
Abstracts of other papers in ESHRE’s three journals: Human Reproduction, Molecular Human Reproduction<br />
& Human Reproduction Update can be accessed post embargo from http://www.oxfordjournals.org/eshre<br />
Papers available on request from Margaret Willson.<br />
Contact (media inquiries only)<br />
Margaret Willson: Tel: +44 (0)1536 772181. Mobile: +44 (0)7973 853347.<br />
Email: m.willson@mwcommunications.org.uk