Is there an association between assisted reproductive technologies and time and complications of the third stage of labor?

Aziz, Michael M.; Guirguis, George; Maratto, Sean; Benito, Carlos; Forman, Eric J.

doi:10.1007/s00404-015-3943-3

Cited by 17 publications

(13 citation statements)

References 8 publications

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“…High oestradiol and progesterone concentrations, as a result of multiple folliculogenesis, may produce suboptimal angiogenesis and placentation, predisposing to PPH. Therefore, a major role may be played by ART procedures themselves, but uterine and hormonal conditions associated with infertility may contribute to the increased failed induction and postpartum complications observed (Stern et al, 2015; Healy et al, 2010; Aziz et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Peripartum and postpartum outcomes in uncomplicated term pregnancy following ART: a retrospective cohort study from two Italian obstetric units

Vannuccini

Ferrata

Perelli

et al. 2018

Human Reproduction Open

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STUDY QUESTION Do singleton uncomplicated term pregnancies conceived by assisted reproductive technology (ART) have adverse peripartum and postpartum outcomes? SUMMARY ANSWER Term pregnancies following ART, even if uncomplicated until birth, have a higher risk of retained placenta and postpartum hemorrhage (PPH). WHAT IS KNOWN ALREADY There is consistent evidence that pregnancies following ART have higher incidence of complications during pregnancy. However, few studies specifically investigated birth outcomes in ART term pregnancies. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was conducted on 14 415 deliveries at two university tertiary care obstetric units. Clinical data were extracted by reviewing obstetric records of all deliveries from 1 January 2010 to 31 December 2014, in a standardized electronic database regarding the mother’s health before and during pregnancy, complications during pregnancy and at birth, and neonatal outcome. PARTICIPANTS/MATERIALS, SETTING, METHODS Following an accurate evaluation of exclusion criteria (multiparity, maternal pre-pregnancy diseases, prior uterine surgery, fetal malformations, intrauterine deaths, elective cesarean section and pregnancy complications), the group of uncomplicated singleton term pregnancies from autologous ART conception by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) ( n = 188) was compared with a maternal age and body mass index (BMI) matched group of spontaneous pregnancies ( n = 1168). Cases of intrauterine insemination (IUI) ( n = 14) and ovulation induction with timed intercourse ( n = 18) were not included. Labor, delivery and postpartum outcomes were evaluated. Odds ratios (OR) were adjusted with multivariable logistic regression to maternal age, BMI, nationality and gestational age at birth. MAIN RESULTS AND THE ROLE OF CHANCE The age of women in the final analysis ranged from 25 to 45 years, while BMI ranged from 17 to 34 kg/m 2 . Uncomplicated term pregnancies with ART conception had a higher risk of operative delivery (adjusted OR 1.40, 95% confidence interval (CI) 1.01–1.95), retained placenta (adjusted OR 2.63, 95% CI 1.31–5.26) and PPH (adjusted OR 2.86 95% CI 1.37–5.99). Conversely, ART conception did not increase the risk of induced labor (adjusted OR 1.18, 95% CI 0.85–1.65). However, patients that conceived by ART and underwent labor induction had a higher risk of failed induction compared with the control group (adjusted OR 2.53, 95% CI 1.23–5.21). Infants born after ART had a similar birthweight, Apgar score and arterial blood pH compared with spontaneously-conceived ones. LIMITATIONS, REASONS FOR CAUTION The database lacked speci...

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Section: Discussionmentioning

confidence: 99%

Peripartum and postpartum outcomes in uncomplicated term pregnancy following ART: a retrospective cohort study from two Italian obstetric units

Vannuccini

Ferrata

Perelli

et al. 2018

Human Reproduction Open

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show abstract

“…In terms of increased PPH after IVF, Aziz et al reported that patients who conceived after receiving oocyte donation without controlled ovarian hyperstimulation were at increased risk for manual placental extraction, and this association was not affected by age differences between groups. However, this may be only one reason for the increased PPH [37]. In addition, reactivity of the uterus to oxytocin may decrease with aging and may be a cause of bleeding [23].…”

Section: Discussionmentioning

confidence: 99%

In Vitro Fertilization Pregnancy is One of the Risk Factor for Atonic Bleeding in Problem-Free Pregnancy

Yanaihara¹,

Ohgi²,

Motomura³

et al. 2017

J Preg Child Health

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“…The authors found a positive association between retained placenta and oocyte donation, as well as between PPH and oocyte donation 15. In another 2016 study by Aziz et al, seeking to determine whether or not length of third stage was related to IVF, the authors concluded that cryopreserved embryo transfer (donated or autologous) without controlled ovarian hyperstimulation was not related to longer third stage, but did significantly increase the risk for manual removal of the placenta 16…”

Section: Risk Factorsmentioning

confidence: 99%

<p>Retained placenta after vaginal delivery: risk factors and management</p>

Perlman¹,

Carusi²

2019

IJWH

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Retained placenta after vaginal delivery is diagnosed when a placenta does not spontaneously deliver within a designated amount of time, variably defined as a period of 18–60 mins. It may also be diagnosed if a patient experiences significant hemorrhage prior to delivery of the placenta. Normal placenta delivery requires adequate uterine contractions, with shearing of the placenta and decidua from the uterine wall and expulsion of the tissue. Thus, retained placenta can occur in the setting of significant uterine atony, abnormally adherent placenta, as with placenta accreta spectrum (PAS), or closure of the cervix prior to placental expulsion. Risk factors for retained placenta parallel those for uterine atony and PAS and include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions. History of a prior retained placenta and congenital uterine anomalies also appear to be risk factors. Management entails manual removal of the placenta with adequate analgesia, as medical intervention alone has not been proven effective. Complications can include major hemorrhage, endometritis, or retained portions of placental tissue, the latter of which can lead to delayed hemorrhage or infection. Prophylactic antibiotics can be considered with manual placenta removal, though evidence regarding effectiveness is inconsistent. If hemorrhage is encountered, deployment of a massive transfusion protocol, uterine evacuation with suction, and use of intrauterine tamponade, as with an intrauterine balloon, should be initiated immediately. When a separation plane between the placenta and uterus is particularly difficult to create, PAS should be considered, and preparations should be made for hemorrhage and hysterectomy. Patients with risk factors for retained placenta should have a laboratory sample sent for blood type and antibody screening on admission to labor and delivery, and plans should be made for appropriate analgesia and preparations for hemorrhage if a retained placenta is encountered.

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Is there an association between assisted reproductive technologies and time and complications of the third stage of labor?

Abstract: Patients who conceived after non-COH ET were at increased risk for manual placental extraction. This association was not influenced by age differences between groups. Further research must be done to determine which elements of the ART process are responsible for these differences.

Cited by 17 publications

References 8 publications

Peripartum and postpartum outcomes in uncomplicated term pregnancy following ART: a retrospective cohort study from two Italian obstetric units

Peripartum and postpartum outcomes in uncomplicated term pregnancy following ART: a retrospective cohort study from two Italian obstetric units

In Vitro Fertilization Pregnancy is One of the Risk Factor for Atonic Bleeding in Problem-Free Pregnancy

<p>Retained placenta after vaginal delivery: risk factors and management</p>

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