Ultrasound Diagnosis of Placental and Umbilical Cord Anomalies in Singleton Pregnancies Resulting From In-vitro Fertilization
Condition: Placenta Diseases; IVF
MeSH terms: Placenta Diseases
Study type: Observational

Summary: 
      Objectives: to identify which type of placental and umbilical cord abnormalities are more
      common in IVF singleton pregnancies; to investigate if heterologous fertilization is an
      additional risk factor for the development of these abnormalities.

      Methods: this was a multicenter prospective cohort study study involving two tertiary centres
      (S. Orsola Hospital, University of Bologna and Institute for Women's Health, University
      College of London). Patients with a singleton pregnancy conceived with IVF were consecutively
      recruited between May 2019 to January 2021. Each case was matched with a control presenting
      with a spontaneous pregnancy during the same period of time. All patients underwent similar
      antenatal care, which included ultrasound examinations at 11-14, 19-22 and 33-35 weeks.
      Ultrasound findings of placental and/or umbilical cord abnormalities were recorded in the two
      groups and confirmed after birth. The incidence of placental/cord findings in the study group
      was assessed using the chi-squared test or Fisher's exact test, where appropriate. Post-hoc
      pairwise comparisons were performed with the Fisher's exact test, using the Simes' method for
      false discovery rate control.
    

Detailed description: 
      This was a multicenter prospective cohort study study involving two tertiary centres (S.
      Orsola Hospital, University of Bologna and Institute for Women's Health and University
      College of London). All patients with a singleton pregnancy conceived with IVF were
      consecutively recruited between 1st of May 2019 to 31st March 2021. Each case was matched
      with a control presenting with a SC during the same period of time.

      All patients had antenatal care using a similar clinical protocol, which included at 11-14
      weeks (nuchal thickness screening scan), 19-22 weeks (detailed fetal anatomy scan) and 33-35
      weeks (growth scan). All ultrasound examinations are carried out transvaginally and/or
      transabdominally by experienced operators using a high-resolution ultrasound equipment.
      Ultrasound findings of placental and/or umbilical cord abnormalities were recorded in each
      case using a standardized reporting protocol including placental location, cord insertion.
      The placenta was recorded as "low lying" when the edge was 0.5-2 cm from the internal os of
      the uterine cervix. When the placenta was <0.5cm from the internal os or completely covering
      it, it was defined as placenta previa (marginal or complete). Ultrasound signs of PAS were
      recorded using the standardized description proposed by the EW-AIP including for grey scale
      imaging: loss of clear zone, myometrial thinning, the presence of placental lacunae; bladder
      wall interruption; placental bulge and focal exophytic mass and for CDI: utero-vesical
      hypervascularity; subplacental hypervascularity; bridging vessels and lacunae feeder vessels.
      Additional transabdominal and transvaginal sonographic (TVS) examinations of the placenta and
      cord insertion were performed at 28-30 weeks and 35-36 weeks when anomalies were identified
      at the 19-22 weeks scan.

      Women with multiple pregnancies or requiring emergency delivery before 32 weeks were excluded
      from the study group. All patients were managed according to local protocols.

      Patient's demographic data, previous obstetric and gynecological history, clinical findings,
      ultrasound data and images and symptoms at the time of the first examination were recorded
      and stored in a specialized database (Viewpoint Version 5, Bildverargeritung GmbH, Munich,
      Germany). All placentas were examined at delivery by the obstetric team and histopathological
      evaluation has been carried out when clinically indicated.
    

Intervention name(s): ultrasound according routine antenatal care
Intervention type(s): Diagnostic Test
Intervention description(s): ultrasound examinations at 11-14, 19-22 and 33-35 weeks
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        All patients with a singleton pregnancy conceived with IVF were consecutively recruited
        between 1st of May 2019 to 31st March 2021. Each case was matched with a control presenting
        with a SC during the same period of time.

        All patients had antenatal care using a similar clinical protocol, which included at 11-14
        weeks (nuchal thickness screening scan), 19-22 weeks (detailed fetal anatomy scan) and
        33-35 weeks (growth scan).