Donor oocyte conception and pregnancy complications: a systematic review and meta-analysis.

BACKGROUND: Observational studies showed that women with a donor oocyte (DO) pregnancy have an increased risk of pregnancy complications. OBJECTIVES: Systematic review and meta-analysis to compare pregnancy complications of DO pregnancy with autologous oocyte in vitro fertilisation (IVF), and whether DO pregnancy acts as an independent risk factor. SEARCH STRATEGY: Online searches of databases from 1 January 1980 to 31 January 2015 were performed using a set of relevant keywords. SELECTION CRITERIA: All studies comparing pregnancy complications of women with donor oocyte IVF and autologous oocyte IVF were included. DATA COLLECTION AND ANALYSIS: Data collected included demographics and pregnancy complications. Methodological quality assessment was performed using the Newcastle-Ottawa scale. Statistical analysis was performed using review manager 5.3 and stata 13.0. Meta-regression was performed for age. MAIN RESULTS: In total, 11 studies (n = 81 752) were included. Ten studies (n = 11 539) examined the primary outcome. The risk of developing hypertensive disorders in pregnancy was significantly higher for DO pregnancy (odds ratio, OR 3.92; 95% confidence interval, 95% CI 3.21-4.78). Further subgroup analysis for singleton and twin pregnancies showed that the risk was significantly higher for DO pregnancy in each group. Secondary outcomes including small for gestational age (OR 1.81), caesarean section (OR 2.71), and preterm delivery (OR 1.34) were significantly higher with DO pregnancy. Meta-regression for the covariate of age suggested that risk was independent of age. AUTHOR'S CONCLUSIONS: Donor oocyte pregnancy acts as an independent risk factor for pregnancy complications, including hypertensive disorders, small for gestational age, and preterm delivery. Women should be counselled carefully before undergoing DO-assisted conception. TWEETABLE ABSTRACT: Donor oocyte conception is an independent risk factor for obstetric complications.

Comparison of techniques used to deliver a deeply impacted fetal head at full dilation: a systematic review and meta-analysis.

BACKGROUND: Second-stage caesarean section with a deeply impacted fetal head is associated with maternal and neonatal complications. OBJECTIVES: Systematic review and meta-analysis to identify, appraise and synthesise existing evidence that evaluated various techniques of delivering a baby with a deeply impacted head at full-dilation caesarean section. The primary outcome was uterine extension and secondary outcomes were other maternal and neonatal morbidities. SEARCH STRATEGY: Online searches of MEDLINE (1946-January 2015), EMBASE (1950-January 2015), Web of Sciences (1950-2015), and the Cochrane Library databases were performed using a set of relevant keywords. SELECTION CRITERIA: All studies that compared the outcome of various techniques of delivering the baby's head at full-dilation caesarean section. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed using the Newcastle-Ottawa scale. Data collected from each of the studies included variables on the participants, comparisons used, and feto-maternal outcomes. Meta-analysis was performed using review manager 5.3. MAIN RESULTS: In total, 12 studies were included. Six studies (n = 455) examined primary outcomes. Meta-analysis showed that the risks of uterine incision extension, infection, mean blood loss, and operative time were significantly higher with the push technique compared with the reverse breech extraction. The evidence to support the Patwardhan method and fetal pillow was inadequate. AUTHORS' CONCLUSIONS: Evidence gathered from observational studies suggests that reverse breech extraction is associated with significantly lower maternal risks compared with the push method. TWEETABLE ABSTRACT: Meta-analysis suggests reverse breech extraction during caesarean section to deliver impacted fetus is safer.