A population based evaluation of the mode of delivery in association with infertility treatment from 1990-2012.
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.


CONCLUSIONS
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.
Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany.
J
J
Reichelt
Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany.
I
I
Kyvernitakis
GQH, Geschäftsstelle Qualitätssicherung Hessen, Eschborn, Germany.
B
B
Misselwitz
Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany.
P
P
Hadji
Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany.
S
S
Schmidt
Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany.
M
M
Kalder
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007246:Infertility / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D011247:Pregnancy; D015995:Prevalence; D055815:Young Adult