Placenta praevia (PP), a term used to describe abnormally low placentation, is associated with maternal and fetal complications. Known risk factors for include maternal age, multiple pregnancy, multiparity, smoking and drug use, and termination of pregnancy. A less well-recognised risk factor is ART however, the underlying pathophysiology remains unclear. Varying theories have been developed ranging from hormonal effects on the endometrium, effects related to the embryo transfer and altered uterine contraction wave patterns. This study investigated the association between ECT (measured prior to embryo transfer) and the relative risk of PP. We found that endometrial thickness in ART cycles is directly proportional to the risk of PP and that this risk is independent of several significant risk factors. It is hypothesised that increased uterine peristalsis and PP may explain the observed increased risk of PP in ART and endometriosis. Further studies are planned to elucidate whether ECT is a surrogate marker of increased uterine contractility or altered endometrial receptivity.
The results for this project were presented at the 5th congress of the Asia Pacific Initiative on Reproduction 2014 and were published in the journal of Human Reproduction in 2014.
Reference: Rombauts L, Motteram C, Berkowitz E, Fernando S. Risk of PP is linked to endometrial thickness in a retrospective cohort study of 4537 singleton assisted reproduction technology births. Hum Reprod. 2014 Dec;29(12):2787-93.