A Population Based Evaluation of the Mode of Delivery in Association with Infertility Treatment from 1990–2012

Abstract

Background: This study refers to population based data and investigates the development of the mode of delivery associated with infertility treatment over the last 23 years.

Methods: All 1 202 557 deliveries in Hesse, Germany, between 1990 and 2012 were assessed. 2.2% of the study population, 26 761, had a delivery subsequent to infertility treatment based on the Hessian Perinatal Registry (HEPE). An evaluation in this subgroup was performed investigating the associations between the mode of delivery and the gestational week and the mother’s age.

Results: A continuous and significant (p<0.01) increase of cesarean section (CS) rates subsequent to infertility treatment (1990: 41,3%; 2012: 55,9%) as well as a conversely also significant (p<0.01) reduction of vaginal operative and spontaneous deliveries associated with infertility treatment between 1990 and 2012 was found. Furthermore, the preterm delivery rate and the proportion of deliveries of parturients older than 35 years of age in association with infertility treatment raised over the last years. Rates of full-term deliveries and deliveries of women younger than 35 years remained stable during the observation period.

Discussion: The rate of cesarean section is continuously rising over the last 23 years with regard to parturients subsequent to infertility treatment. The CS rate is significantly higher compared to women with a spontaneous pregnancy and in comparison to the data from 20 years ago. Most recently, the number of CS (51,2%) exceeded the number of vaginal deliveries (48,8%) in Hesse subsequent to infertility treatment for the first time.

Zusammenfassung

Hintergründe: Dieser Arbeit liegen populationsbezogene Daten zu Grunde. Es soll die Entwicklung des Geburtsmodus nach Sterilitätsbehandlung in den letzten 23 Jahren untersucht werden.

Methoden: Alle 1 202 557 Entbindungen in Hessen, Deutschland, von 1990 bis 2012 wurden ausgewertet. Basierend auf den Daten der Hessischen Perinatalerhebung erfolgte die Entbindung bei 2,2% der Studienpopulation, 26 761, nach einer Infertilitätsbehandlung. Diese Subgruppe wurde auf Hinweise zu Verbindungen zwischen dem Entbindungsmodus und dem Gestationsalter beziehungsweise dem Alter der Mutter untersucht.

Ergebnisse: Die HEPE-Daten zeigen einen kontinuierlichen und signifikanten (p<0,01) Anstieg der Sectiorate nach Sterilitätsbehandlung (1990: 41,3%; 2012: 55,9%) und zudem eine reziproke und ebenfalls signifikante (p<0,01) Reduktion an vaginal operativen und spontanen Geburten bei Frauen nach Sterilitätsbehandlung. Sowohl die Rate an Frühgeburten, als auch der Schwangeren mit einem Lebensalter über 35 Jahren stieg besonders in den letzten Jahren an. Hingegen blieben im gleichen Kollektiv der Anteil an Geburten ab 37+0 Wochen und Schwangeren unter 35 Jahren über den Beobachtungszeitraum nahezu konstant.

Diskussion: Die Rate an Kaiserschnitten zeigt bei Frauen nach Sterilitätsbehandlung einen kontinuierlichen Anstieg. Im Vergleich zu spontan eingetretenen Schwangerschaften und verglichen mit den Daten zu Beginn der neunziger Jahre des vergangenen Jahrhunderts ist diese signifikant erhöht. Zuletzt übertraf in Hessen nach Sterilitätsbehandlung die Rate der Kaiserschnitte (51,2%) erstmals die der vaginalen Entbindungen (48,8%).

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