[Frequency of caesarean sections amongst single-foetus births following infertility treatment: an investigation by the Hessian Perinatal Registry (HEPE)].
OBJECTIVE
This study investigates which factors increase the probability of the need to perform a Caesarean section in an uncomplicated single-foetus pregnancy following infertility treatment.


METHODS
The Hessian Perinatal Registry (HEPE) was used as a basis to determine the development of the rate of Caesarean sections and the delivery method for births in 2007. It is linked to anamnestic and perinatal risks and the foetal and maternal outcome.


RESULTS
The total rate of Caesarean sections in the state of Hesse has doubled in a period of over 15 years and stood at 33.0 % in 2007. The same period also saw a rise in the percentage of births that followed infertility treatment, for which an increased risk for multiple-foetus pregnancies can be verified. A comparison of mature single-foetuses in cephalic presentation (at 37-41 weeks gestation) with and without preceding infertility treatment shows the risk involved for Caesarean section to have increased (caesarean section rate 24.7 vs. 31.2 %). The higher rate of Caesarean sections following infertility treatment is associated with higher pregnancy risks (family history, allergies, obesity, premature contractions) and can lead to a higher rate of labour induction, but remains an independent risk even after these factors have been controlled (OR = 1.74, 95 % CI = 1.68-1.79).


CONCLUSIONS
The risks for Caesarean section are increased even for uncomplicated pregnancies when they follow infertility treatment. It can be assumed that, amongst other things, increased safety needs for couples and doctors together with more high-tech intensive care of pregnancies following infertility treatment will be required. In the event of a planned Caesarean section, comprehensive explanation of the risks involved will be necessary.
Kolip
P
P
Institut für Public Health und Pflegeforschung der Universität Bremen, Bremen, Germany. kolip@uni-bremen.de
Misselwitz
B
B
Schmidt
S
S
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012042:Registries; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055815:Young Adult