OBSTETRIC OUTCOME IN 232 OVUM DONATION PREGNANCIES

Objective To study the obstetric outcome of ovum donation pregnancies. Design A retrospective analysis of 232 ovum donation pregnancies in t he six years from 1988 to 1993. Setting Infertility clinic in a privat e hospital. Participants All ovum donation recipients that achieved pr egnancy in the clinic during the stated time period. Main outcome meas ures Percentages of live birth and miscarriages and ectopic pregnancie s; number of sacs identified in the uterus at early (four weeks after transfer) and later scans; incidence of antepartum and postpartum haem orrhage; incidence of pregnancy-induced hypertension; incidence of pre term, low birthweight and small-for-gestational age babies; and incide nce of operative deliveries. Results Of 232 pregnancies, 151 babies we re born (live birth rate of 20%); and 81 were lost (57 before eight we eks, 17 after eight weeks and seven ectopic pregnancies). In nine case s there were no intrauterine sacs at the early scan (two 'chemical pre gnancies' and seven ectopic pregnancies). In 169 cases there was initi ally one intrauterine sac, ending with 102 singleton deliveries (60%); in 47 cases there were initially two intrauterine sacs, ending with 1 1 singleton deliveries (23%) and 32 twin deliveries (68%); in the seve n cases where three sacs were identified initially, there were no sing leton deliveries, three twin deliveries (one selective fetal reduction ) and three triplet deliveries. Women with premature ovarian failures had a significantly higher pregnancy rate compared with those with fun ctioning ovaries (P < 0.02). However, in the former group, the miscarr iage rate was also significantly higher (P < 0.03) so that the number of term births was similar. The incidence of vaginal bleeding was 12% in the first trimester, 1.5% in the second trimester, and 2% in the th ird trimester. The incidence of postpartum haemorrhage was 12%. Thirty -two women had pregnancy-induced hypertension (23% of all deliveries). This occurred in 22/105 singletons (21%), 7/32 twins (22%) and in all three (100%) of the triplets. In the singleton group 13% of infants w ere preterm, 18% had a birthweight < 2.5 kg and 15% were < 3rd centile for birthweight at delivery (small-for-gestational age). Ovarian func tion was found to be the only factor that significantly influenced the incidence of small-for-gestational age babies (odds ratio 8.84; 95% c onfidence interval 1.1-70.0; P = 0.007). The overall operative deliver y rate was 85% with the caesarean section rate being 69%. Conclusions Women who become pregnant following oocyte donation should be consider ed obstetrically as high risk, especially those with ovarian failure b ecause of the increased incidence of small-for-gestational age infants in these pregnancies. They are also at higher risk of pregnancy-induc ed hypertension and postpartum haemorrhage.