Aziz Michael Matean, Guirguis George, Maratto Sean, Benito Carlos, Forman Eric J
Department of Obstetrics, Gynecology, and Women's Health, Atlantic Health System, 100 Madison Avenue, Interoffice Box#20, Morristown, NJ, 07960, USA.
Division of Maternal-Fetal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
Arch Gynecol Obstet. 2016 Jun;293(6):1193-6. doi: 10.1007/s00404-015-3943-3. Epub 2015 Nov 2.
To determine if vaginal deliveries exposed to assisted reproductive technologies (ART) are associated with an increased time between delivery of the neonate and placenta and select complications.
A retrospective cohort of patients enrolled in an infertility practice who had term, singleton, vaginal deliveries at two academic hospitals from 2008 to 2013 was analyzed. Controls were patients with spontaneous conceptions after infertility consultations. The exposure groups were patients with controlled ovarian hyper-stimulation (COH) with in vivo fertilization, COH with in vitro fertilization and fresh embryo transfer (COH/IVF), and frozen embryo transfer or oocyte donation recipients without COH (non-COH ET). Multiple gestations and stillbirths were excluded. Median time of third stage was compared using the Mann-Whitney U test. Secondary outcomes of retained placenta, manual placental extraction, and post-partum hemorrhage (PPH) were compared using Chi-square or Fisher's exact analyses.
A total of 769 patients met criteria and were analyzed. While there were no differences in time of third stage of labor, retained placenta, or PPH, manual extraction was significantly more common among non-COH ET [age-adjusted OR 5.6 (95 % CI 2.2-13.8); p < 0.001].
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.
确定接受辅助生殖技术（ART）的阴道分娩是否与新生儿和胎盘娩出间隔时间延长及特定并发症相关。
对2008年至2013年在两家学术医院接受不孕症治疗并足月单胎阴道分娩的患者进行回顾性队列分析。对照组为不孕症咨询后自然受孕的患者。暴露组为接受体内受精的控制性卵巢过度刺激（COH）患者、接受体外受精和新鲜胚胎移植的COH患者（COH/IVF）以及未接受COH的冷冻胚胎移植或卵母细胞捐赠受者（非COH ET）。排除多胎妊娠和死产。使用Mann-Whitney U检验比较第三产程的中位时间。使用卡方检验或Fisher精确分析比较胎盘残留、人工胎盘剥离和产后出血（PPH）的次要结局。
共有769例患者符合标准并进行了分析。虽然第三产程时间、胎盘残留或PPH方面没有差异，但人工剥离在非COH ET中明显更常见[年龄调整后的OR为5.6（95%CI 2.2-13.8）；p<0.001]。
非COH ET后受孕的患者人工胎盘剥离风险增加。这种关联不受组间年龄差异的影响。必须进行进一步研究以确定ART过程中的哪些因素导致了这些差异。
