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Labour pain relief in women with assisted conception and its effects on labour and birth outcomes

02 April 2018
13 min read
Volume 26 · Issue 4

Abstract

Background

Increased use of assisted reproduction technology has resulted in concerns about its impact on maternal and neonatal wellbeing.

Aims

To evaluate the labour and birth outcomes in women who had and had not undertaken assisted conception and how the use of labour pain relief affected their outcomes

Methods

Women who had and had not undertaken assisted conception were studied, and the effects of labour pain relief on labour and birth outcomes evaluated.

Findings

The results showed that women who had undertaken assisted conception were more likely to have had epidural analgesia during labour. However, after adjusting for country of birth, body mass index (BMI), maternal age, model of care during pregnancy and gestational hypertension, this difference was not statistically significant. Regression analysis showed no differences between the groups in use of oxytocin, mode of birth, episiotomy or tear, postpartum blood loss, Apgar score at 5 minutes and neonatal complications at birth (P>0.05).

Conclusions

These findings demonstrate the factors leading to poor outcomes in women who undertake assisted conception, and will help to reduce obstetric complications in this population.

With the improvement of assisted reproduction technology, and greater public awareness, a growing number of children are born to women with a history of infertility (Sutcliffe and Ludwig, 2007). Despite its high success rate, there are concerns about the impact of assisted conception on maternal and neonatal wellbeing. Compared with women who spontaneously conceive, women who undertake assisted conception experience greater levels of depression (Fisher et al, 2012), more negative pregnancy outcomes, unfavourable birth experiences and more negative neonatal outcomes (Giallo et al, 2011; Cooklin et al, 2012; Giallo et al, 2014). Several studies have suggested an association between assisted conception and an increased rate of gestational diabetes, pre-eclampsia and caesarean delivery. Neonatal outcomes have also been reported to be poor: babies born as a result of assisted conception are more likely to be admitted to the neonatal intensive care unit, and have an increased risk of congenital abnormalities, low birth weight and preterm delivery (Hammarberg et al, 2008a; 2008b; McGrath et al, 2010). However, controversial results have been reported by Shevell et al (2005), who indicated no association between assisted conception and fetal growth restriction, or fetal anomalies.

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