Antenatal management of singleton pregnancies conceived using assisted reproductive technology TOG 2019

Question 1

Incidence of following early pregnancy complications in ART:
Mild OHSS
Mod/severe OHSS
Miscarriage
Ectopic

Answer 1

Mild OHSS 33%
Mod/severe OHSS 8%
Miscarriage 15-20%
Ectopic 1.4%

Question 2

In OHSS - what to consider risk VTE

Answer 2

Incidence as high as 10%
Can be upper body/arterial system
Prophylaxis should be recommended with severe OHSS or other RF. Continue at least until end of 1st trimester

Question 3

ART pregnancies are at likely higher risk of which maternal conditions

Answer 3

PIH/PET
GDM
VTE

Likely related to cause of subfertilty (age, PCOS etc)
Not reason alone to give aspirin, LMWH or OGTT

Question 3

Screening for SGA from GTG

Answer 3

If 3 RF (IVF, PO - anything else >35, BMI <20 or 24-30) Then get UAD 20-24 & 3rd trimester USS

Question 4

When should timing of delivery be offered if no other concerns?

Answer 4

IOL at term - slightly higher risk of stillbirth

Question 5

Fetal complications associated with ART

Answer 5

30-40% increased risk structural abnormality
FGR
Stillborth
PTM- 11% increased risk ?iatrogenic

Question 6

Placental complications following ART?

Answer 6

Placenta praevia
Accreta
Abruption
Vasa praevia