Reproductive outcomes in women with prior cesarean section undergoing in vitro fertilization: A retrospective case-control study

Abstract

The impact of prior cesarean section (CS) on the pregnancy and neonatal outcomes of in vitro fertilization and embryo transfer (IVF-ET) was investigated. A retrospective analysis was performed on 144 patients with prior CS between January 2013 and December 2015. The pregnancy, delivery, and neonatal outcomes of patients who had previous CS delivery and received IVF-ET were analyzed. The control group comprised 166 patients who had only previous vaginal delivery (VD) and received IVF-ET during the same period. The results showed that the basal follicle stimulating hormone level, estradiol level on human chorionic gonadotropin (hCG) day, gonadotrophin dosage, duration of stimulation, retrieved oocytes, fertilization rate, high-quality embryo rate, multiple birth rate, abortion rate and ectopic pregnancy rate had no significant difference between the two groups (P>0.05). The pregnancy rate (40.28% vs. 54.22%) and implantation rate (24.01% vs. 34.67%) were significantly lower (P<0.05), and the ratio of embryo difficulty transfer (9/144 vs. 0/166) was significantly higher in CS group than in VD group. The risk of pernicious placenta previa and postpartum hemorrhage in twin deliveries was significantly increased in CS group as compared with that in VD group (P<0.05), and gestational age and neonatal birth weight were significantly reduced in twin deliveries as compared with singleton deliveries in both groups (P<0.05). It was suggested that the existence of CS scar may impact embryo implantation and clinical pregnancy outcome, and increase the difficulty of ET. We should limit the number of transfer embryos to avoid multiple pregnancies and strengthen gestational supervision in patients with cesarean scar.

Keywords

cesarean section / in vitro fertilization and embryo transfer / pregnancy / complication

References

[1] SchemannK, PattersonJA, NippitaTA, et al. . Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study. BMC Pregnancy Childbirth, 2015, 15: 179 PMID: 26285692 PMCID: 4545707

[2] BetránAP, YeJ, MollerAB, et al. . The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One, 2016, 11(2): e0148343 PMID: 26849801 PMCID: 4743929

[3] MillerES, HahnK, GrobmanWA. Consequences of a primary elective cesarean delivery across the reproductive life. Obstet Gynecol, 2013, 121(4): 789-797 PMID: 23635679

[4] GregoryKD, JacksonS, KorstL, et al. . Cesarean versus vaginal delivery: whose risks? Whose benefits. Am J Perinatol, 2012, 29(1): 7-18 PMID: 21833896

[5] NajiO, WynantsL, SmithA, et al. . Does the presence of a caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy assessment unit?. Hum Reprod, 2013, 28(6): 1489-1496 PMID: 23585560

[6] Ben-NagiJ, WalkerA, JurkovicD, et al. . Effect of cesarean delivery on the endometrium. Int J Gynaecol Obstet, 2009, 106(1): 30-34 PMID: 19356756

[7] ZhangNY, ChenH, XuZP, et al. . Pregnancy, delivery, and neonatal outcomes of in vitro fertilization-embryo transfer in patient with previous cesarean scar. Med Sci Monit, 2016, 22: 3288-3295 PMID: 27636504 PMCID: 5027857

[8] WangCB, ChiuWW, LeeCY, et al. . Ceasarean scar defect: correlation between cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstetric Gynecol, 2009, 34(1): 85-89

[9] YaziciogluF, GokdoganA, KelekciS, et al. . Incomplete healing of the uterine incision after caesarean section: Is it preventable. Eur J Obstet Gynecol Reprod Biol, 2006, 124(1): 32-36 PMID: 16023780

[10] LandonMB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol, 2010, 34(4): 267-271 PMID: 20654777

[11] WojdeckiJ, GrynsztajnA. Scar formation in the uterus after cesarean section. Am J Obstet Gynecol, 1970, 107(2): 322-324 PMID: 5441708

[12] MorrisH. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms. Int J Gynecol Pathol, 1995, 14(1): 16-20 PMID: 7883420

[13] LumbiganonP, LaopaiboonM, GulmezogluAM, et al. . Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet, 2010, 375(9713): 490-499 PMID: 20071021

[14] NajiO, DaemenA, SmithA, et al. . Does the presence of a cesarean section scar influence the site of placental implantation and subsequent migration in future pregnancies: a prospective case-control study. Ultrasound Obstet Gynecol, 2012, 40(5): 557-561 PMID: 22323094

[15] BullettiC, De ZieglerD. Uterine contractility and embryo implantation. Curr Opin Obstet Gynecol, 2005, 17(3): 265-276 PMID: 15870561

[16] BrosensJJ, GellersenB. Something new about early pregnancy: decidual biosensoring and natural embryo selection. Ultrasound Obstet Gynecol, 2010, 36(1): 1-5 PMID: 20582930

[17] Ofili-YeboviD, Ben-NagiJ, SawyerE, et al. . Deficient lower-segment cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol, 2008, 31(1): 72-77 PMID: 18061960

[18] AllornuvorGF, XueM, ZhuX, et al. . The definition, aetiology, presentation, diagnosis and management of previous caesarean scardefects. J Obstet Gynaecol, 2013, 33(8): 759-763 PMID: 24219709

[19] ArmstrongV, HansenWF, van VoorhisBJ, et al. . Detection of cesarean scars by transvaginal ultrasound. Obstet Gynecol, 2003, 101(1): 61-65 PMID: 12517646

[20] ThurmondAS, HarveyWJ, SmithSS. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med, 1999, 18(1): 13-16 PMID: 9952074

[21] PatounakisG, OzcanMC, ChasonRJ, et al. . Impact of a prior cesarean delivery on embryo transfer: a prospective study. Fertil Steril, 2016, 106(2): 311-316 PMID: 27087400 PMCID: 4975618

[22] RyoE, SakuraiR, KamataH, et al. . Changes in uterine flexion caused by cesarean section: correlation between post-flexion and deficient cesarean section scars. J Med Ultrason (2001), 2016, 43(2): 237-242

[23] SazonovaA, KallenK, Thurin-KjellbergA, et al. . Neonatal and maternal outcomes comparing women undergoing two in vitro fertilization (IVF) singleton pregnancies and women undergoing one IVF twin pregnancy. Fertil Steril, 2013, 99(3): 731-737 PMID: 23219009

[24] GetahunD, OyeleseY, SalihuHM, et al. . Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol, 2006, 107(4): 771-778 PMID: 16582111

[25] Marjolein Bij de VaateAJ, LinskensIH, van der VoetLF, et al. . Reproducibility of three-dimensional ultrasound for the measurement of a niche in a caesarean scar and assessment of its shape. Eur J Obstet Gynecol Reprod Biol, 2015, 188: 39-44 PMID: 25770846

[26] RobergeS, BoutinA, ChailletN, et al. . Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol, 2012, 29(6): 465-471 PMID: 22399223

[27] KessousR, SheinerE. Is there an association between short interval from previous cesarean section and adverse obstetric and perinatal outcome?. J Matern Fetal Neonatal Med, 2013, 26(10): 1003-1006 PMID: 23311913

[28] NguyenTV. Vaginal birth after cesarean section at the University of Texas. J Repord Med Gynecol, 1992, 37(10): 880-882

[29] BujoldE, MehtaSH, BujoldC, et al. . Interdelivery interval and uterine rupture. Am J Obstet Gynecol, 2002, 187(5): 1199-1202 PMID: 12439503

[30] GilliamM, RosenbergD, DavisF. The likelihood of placenta previa with greater number of cesarean deliveries and higher parit. Obstet Gynecol, 2002, 99(6): 976-980 PMID: 12052584

[31] Gyamfi-BannermanC, GilbertS, LandonMB, et al. . Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol, 2012, 120(6): 1332-1337 PMID: 23168757 PMCID: 3545277

[32] KaplanogluM, BulbulM, KaplanogluD, et al. . Effect of multiple repeat cesarean sections on maternal morbidity: data from southeast Turkey. Med Sci Monit, 2015, 21: 1447-1453 PMID: 25989945 PMCID: 4450602

[33] OkumuraM, FranciscoRP, KondoMM, et al. . EP14.03: Ultrasound diagnosis and evaluation of the number of prior caesarean deliveries as risk factor for placenta accreta in placenta previa cases. Ultrasound Obstet Gynecol, 2016, 48(Suppl1): 323