Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France.
Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, Dijon, France.
BJOG. 2024 Feb;131(3):300-308. doi: 10.1111/1471-0528.17625. Epub 2023 Aug 7.
To investigate the effect on major postpartum haemorrhage (PPH) of mode of conception, differentiating between naturally conceived pregnancies, fresh embryo in vitro fertilisation (fresh-IVF) and frozen embryo transfer (frozen-IVF).
Retrospective cohort study.
The French Burgundy Perinatal Network database, including all deliveries from 2006 to 2020, was linked to the regional blood centre database.
In all, 244 336 women were included, of whom 240 259 (98.3%) were singleton pregnancies.
The main analyses were conducted in singleton pregnancies, including 237 608 naturally conceived, 1773 fresh-IVF and 878 frozen-IVF pregnancies. Multivariate logistic regression models adjusted on maternal age, body mass index, smoking, parity, induction of labour, hypertensive disorders, diabetes, placenta praevia and/or accreta, history of caesarean section, mode of delivery, birthweight, birth place and year of delivery, were used.
Major PPH was defined as PPH requiring blood transfusion and/or emergency surgery and/or interventional radiology.
The prevalence of major PPH was 0.74% (n = 1749) in naturally conceived pregnancies, 1.92% (n = 34) in fresh-IVF pregnancies, and 3.30% (n = 29) in frozen-IVF pregnancies. The risk of major PPH was higher in frozen-IVF pregnancies than in both naturally conceived pregnancies (adjusted odds ratio [aOR] 2.63, 95% CI 1.68-4.10) and fresh-IVF pregnancies (aOR 2.78, 95% CI 1.44-5.35).
We found that frozen-IVF pregnancies have a higher risk of major PPH and they should be subject to increased vigilance in the delivery room.
探讨不同受孕方式（自然受孕、新鲜胚胎体外受精（fresh-IVF）和冷冻胚胎移植（frozen-IVF））对产后大出血（PPH）的影响，区分主要 PPH。
回顾性队列研究。
法国勃艮第围产期网络数据库，包括 2006 年至 2020 年的所有分娩数据，与区域血液中心数据库相关联。
共纳入 244336 名女性，其中 240259 名（98.3%）为单胎妊娠。
主要分析在单胎妊娠中进行，包括 237608 例自然受孕、1773 例新鲜-IVF 和 878 例冷冻-IVF 妊娠。多变量逻辑回归模型调整了产妇年龄、体重指数、吸烟、产次、引产、高血压疾病、糖尿病、前置胎盘和/或胎盘植入、剖宫产史、分娩方式、出生体重、分娩地点和分娩年份。
主要 PPH 定义为需要输血和/或紧急手术和/或介入放射治疗的 PPH。
自然受孕妊娠中主要 PPH 的发生率为 0.74%（n=1749），新鲜-IVF 妊娠中为 1.92%（n=34），冷冻-IVF 妊娠中为 3.30%（n=29）。与自然受孕妊娠（调整比值比[aOR]2.63，95%CI1.68-4.10）和新鲜-IVF 妊娠（aOR2.78，95%CI1.44-5.35）相比，冷冻-IVF 妊娠发生主要 PPH 的风险更高。
我们发现冷冻-IVF 妊娠发生主要 PPH 的风险更高，在产房应加强警惕。
