Prelabour caesarean section following IVF/ICSI in older-term nulliparous women: too precious to push?

Abstract

Objective: To compare prelabour caesarean section (CS) rates in older nulliparous women with a term singleton baby in cephalic presentation conceiving spontaneously and through IVF/ICSI. When the latter women would ask for CS, how willing are gynaecologists to comply with that request?

Methods: A population-based retrospective (1995-2009) cohort study, conducted in Northern Belgium. A comparison of 1,866 nulliparous women pregnant after IVF/ICSI and 15,228 controls is made. An anonymous postal questionnaire is sent to all Belgian gynaecologists.

Result: Both groups are comparable with respect to maternal age, gestational age, and birth weight. Prelabour CS is more often performed in women who conceived through IVF/ICSI compared to those who conceived spontaneously (9.2% versus 6.3%, P < 0.001). One in five gynaecologists agrees with the maternal request.

Conclusion: IVF/ICSI pregnancies in older nulliparous women more often end in a prelabour CS and a substantial number of gynaecologists go along with a nonmedical reason for CS.

Figure 1

Answers of Belgian gynaecologists concerning a “nulliparous woman of 38 years, pregnant through IVF after 4 attempts and requesting a prelabour caesarean section”.