Antenatal management of singleton pregnancies conceived using assisted reproductive technology

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Antenatal Management of Singleton Pregnancies Conceived Using ART Richardson A et al. Antenatal management of singleton pregnancies conceived using assisted reproductive technology. TOG 2020;22:34–44. doi:10.1111/tog.12608

5M+ RR 1.49 OR 2.4 BABIES BORN VIA ART WORLDWIDE PIH/PRE-ECLAMPSIA VS SPONTANEOUS STILLBIRTH (95% CI 1.59–3.63)

DO N' T-M IS S FA C TS

1. ART alone is NOT an indication for aspirin or a GTT – base decisions on standard risk-factor assessment only

2. ART is itself a VTE risk factor (~4-fold higher in 1st trimester) – prophylaxis from 1st trimester if ≥3 additional risk factors, from 28 weeks if ≥2

3. Severe/critical OHSS: UK clinics have a legal duty to report to HFEA; thrombosis can present weeks after apparent OHSS resolution

4. Structural abnormality absolute risk stays low (6.5–7% vs 5%) despite 30–40% relative increase – no extra surveillance needed

5. Stillbirth OR 2.4 in singleton ART pregnancies – consider induction of labour at term

6. Calculate EDD from oocyte retrieval date, not CRL; use donor’s age (not recipient’s) for Down syndrome risk if donor eggs used

7. Low-lying placenta at anomaly scan → transvaginal USS + colour Doppler to exclude vasa praevia

8. Only heparin (antiphospholipid syndrome + RM) and progesterone (ART luteal support) are evidence-recommended ‘add- ons’ – aspirin, hCG, immunotherapy, steroids, G-CSF are not

EVIDENCE TIERS AT A GLANCE

Recommended: heparin (APS+RM), progesterone (luteal support)

Not recommended: aspirin, hCG, immunotherapy, steroids, G-CSF (RM/RIF add-ons)

ABBREVIATION KEY

ART — assisted reproductive technology PCOS — polycystic ovary syndrome

IVF — in vitro fertilisation FGR — fetal growth restriction

ICSI — intracytoplasmic sperm injection RM — recurrent miscarriage

OHSS — ovarian hyperstimulation syndrome RIF — recurrent implantation failure

HFEA — Human Fertilisation and Embryology Authority SCH — subclinical hypothyroidism

VTE — venous thromboembolism NIPT — non-invasive prenatal testing (cell-free fetal DNA)

PIH — pregnancy-induced hypertension CRL — crown–rump length

GDM — gestational diabetes mellitus LMWH — low molecular weight heparin

GTT — glucose tolerance test ASRM — American Society for Reproductive Medicine

IADPSG — International Association of Diabetes and Pregnancy G-CSF — granulocyte colony-stimulating factor Study Groups uNK — uterine natural killer (cells)

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — 2020;22:34–44. doi:10.1111/tog.12608

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