Wertheimer Avital, Melamed Sharon, Ashwal Eran, Sapir Onit, Oron Galia, Ben-Haroush Avi, Shochat Tzippy, Wiznitzer Arnon, Shufaro Yoel
IVF Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Matern Fetal Neonatal Med. 2022 Feb;35(4):663-667. doi: 10.1080/14767058.2020.1730797. Epub 2020 Feb 23.
Pregnancies conceived by fertilization (IVF) are associated with a higher prevalence of perinatal complications than pregnancies conceived spontaneously, even after correction of confounding factors. Little is known about the prevalence of complications of the third stage of labor in IVF pregnancies.
To compare the prevalence and types of complications of the third stage of labor following vaginal delivery of singleton infants born to matched groups of women who conceived through IVF or spontaneously.
A retrospective case-control study design was used. The electronic delivery files of a tertiary medical center were reviewed for all women with a singleton IVF pregnancy who gave birth by vaginal delivery from August 2011 to March 2014. The women were matched 1:2 for age, gravidity, parity, and week of delivery to women with a singleton spontaneously conceived pregnancy who gave birth by vaginal delivery during the same period at the same hospital. The impact of mode of conception on the length and complications of the third stage of labor was evaluated.
The study group consisted of 242 women with IVF pregnancies (cases), and 484 matched controls with spontaneously conceived pregnancies (controls). The length of the third stage was similar in the cases and controls (14.23 ± 8.89 and 13.69 ± 9.19 min, respectively). IVF pregnancy was associated with a significantly higher rate of postpartum hemorrhage (PPH) (5.79 versus 1.45%, = .001), manual removal of retained placenta (11.98 versus 7.02%, = .025), and blood transfusion (2.07 versus 0.41%, = .032). On multivariate analysis, pregnancy conceived by IVF was an independent risk factor for an adverse outcome of the third stage of labor (OR 2.86, 95% CI 1.53-5.33).
After correction for confounders, IVF conception proved to be a significant independent risk factor for PPH, manual removal of the placenta, and blood transfusion in the third stage of labor. Therefore, the management of women who give birth vaginally following IVF pregnancy should be designed to anticipate complications in the third stage even in the absence of other risk factors.
与自然受孕的妊娠相比，体外受精（IVF）受孕的妊娠即使在校正混杂因素后，围产期并发症的发生率仍较高。关于IVF妊娠第三产程并发症的发生率知之甚少。
比较通过IVF受孕或自然受孕的匹配组妇女阴道分娩单胎婴儿后第三产程并发症的发生率和类型。
采用回顾性病例对照研究设计。回顾了一家三级医疗中心2011年8月至2014年3月期间所有通过阴道分娩单胎IVF妊娠妇女的电子分娩档案。将这些妇女与同期在同一家医院通过阴道分娩单胎自然受孕妊娠的妇女按年龄、孕次、产次和分娩孕周进行1:2匹配。评估受孕方式对第三产程长度和并发症的影响。
研究组包括242例IVF妊娠妇女（病例组）和484例匹配的自然受孕妊娠对照（对照组）。病例组和对照组的第三产程长度相似（分别为14.23±8.89分钟和13.69±9.19分钟）。IVF妊娠与产后出血（PPH）发生率显著较高相关（5.79%对1.45%，P = 0.001）、徒手剥离胎盘（11.98%对7.02%，P = 0.025）和输血（2.07%对0.41%，P = 0.032）。多因素分析显示，IVF受孕是第三产程不良结局的独立危险因素（OR 2.86，95%CI 1.53 - 5.33）。
校正混杂因素后，IVF受孕被证明是第三产程PPH、徒手剥离胎盘和输血的重要独立危险因素。因此，即使没有其他危险因素，对IVF妊娠后阴道分娩的妇女进行管理时也应考虑到第三产程的并发症。
