Complications of the third stage of labor in in vitro fertilization pregnancies: an additional expression of abnormal placentation?

Herman, Hadas Ganer; Farhadian, Yasmin; Alon, Ayala Shevach; Mizrachi, Yossi; Ariel, Dean; Raziel, Arieh; Bar, Jacob; Kovo, Michal

doi:10.1016/j.fertnstert.2020.10.004

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…38,39 Higher rates of retained placenta were also found in infertile women, implying a possible association between decidualization and placentation defects. 40 A female fetus was another independent risk factor for retained placenta in our cohort. This association was described previously 15 and was also demonstrated in cases of placenta accreta.…”

Section: Discussionmentioning

confidence: 61%

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Risk factors for retained placenta in a first pregnancy—A clinical trial

Cohen

Kovo

Biron‐Shental

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo evaluate potential risk factors for retained placenta in a first pregnancy.MethodThis retrospective case–control study included all primigravida with a singleton, live, vaginal birth at 24 weeks or later, at a tertiary hospital, 2014–2020. The cohort was divided into those with retained placenta versus controls. Retained placenta was defined as the need for manual extraction of the placenta or portions of it, immediately postpartum. Maternal and delivery characteristics, and obstetric and neonatal adverse outcomes, were compared between groups. Multivariable regression was performed to reveal potential risk factors for retained placenta.ResultsAmong 10 796 women, 435 (4.0%) had retained placenta and 10 361 (96.0%) controls did not. Multivariable logistic regression revealed nine potential risk factors for retained placenta: abruption (adjusted odds ratio [aOR] 3.58, 95% confidence interval [CI] 2.36–5.43), hypertensive disorders (aOR 1.74, 95% CI 1.17–2.57), prematurity (<37 weeks, aOR 1.63, 95% CI 1.13–2.35), maternal age older than 30 years (aOR 1.55, 95% CI 1.27–1.90), intrapartum fever (aOR 1.48, 95% CI 1.03–2.11), lateral placentation (aOR 1.39, 95% CI 1.01–1.91), oxytocin administration (aOR 1.39, 95% CI 1.11–1.74), diabetes mellitus (aOR 1.35, 95% CI 1.01–1.79), and female fetus (aOR 1.26, 95% CI 1.03–1.53).ConclusionRetained placentas in first deliveries are associated with obstetric risk factors, some of which could be related to abnormal placentation.

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Section: Discussionmentioning

confidence: 61%

“…The theory behind this relation is rooted in the blunted hormonal response of the aging uterus, resulting in decidualization and placentation defects 38,39 . Higher rates of retained placenta were also found in infertile women, implying a possible association between decidualization and placentation defects 40 …”

Section: Discussionmentioning

confidence: 99%

Risk factors for retained placenta in a first pregnancy—A clinical trial

Cohen

Kovo

Biron‐Shental

et al. 2023

Intl J Gynecology & Obste

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“…In our center, when the endometrium cannot meet 7mm using routine dosage of Progynova, we will add Femoston, which in turn resulted a higher cumulative estrogen dose and duration. This has been attributed to reduced endometrial thickness ( 17 ), but high-dose estrogen alone may also affect obstetric outcomes and placental findings. Recently published data also showed a similar phenomenon that the higher estrogen dose administered resulted in a higher rate of bilobated placentas, accessory lobes, accelerated villous maturation ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Programmed frozen embryo transfer cycles are associated with a higher risk of abnormal placental development: a retrospective cohort study of singleton live births

Wang

Song

et al. 2023

Front. Endocrinol.

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IntroductionAbnormal placental development can lead to adverse outcomes for both mother and fetus. The effect of different types of endometrium preparation regimens of frozen-thawed cycles on the placental development features associated with the perinatal outcomes remains unclear. Hence, we conducted a retrospective cohort study to assess the impact of specific endometrial preparation regimens on placenta-mediated pregnancy complications in singleton live births.MethodsA retrospective cohort study was conducted evaluating data of all singleton live births both conceived naturally or by in vitro fertilization (IVF) therapy from 2018 to 2020 at our hospital. Two exposed groups of frozen-thawed embryo transfer (FET) were created by the endometrium preparation regimen as the modified natural cycles (mNC) and the programmed cycles. The nonexposed group was the singleton pregnancies conceived naturally. The obstetrical and perinatal outcomes were compared among the three groups using multivariate analysis to adjust the results for determinants potentially associated with the abnormal placental development.ResultsA total of 2186 pregnant women with singleton live births were included in our final analysis and were divided into three groups as naturally conceived group (n=1334), mNC-FETs group (n=217) and programmed-FETs group(n=635). After adjusting for maternal age and parity, no significant difference was observed on the risk of placental disorders between mNC-FET cycles and natural conceived pregnancies (aOR 1.16; 95%CI 1.31-7.01), while programmed-FET cycles were associated with a higher occurrence of placental disorders (aOR 5.36; 95%CI 3.63-8.05). Using the mNC-FET group as a reference and adjusting for confounders such as maternal age, parity, endometrial thickness, and number of embryos transferred, we found that the main manifestation of abnormal placentation in programmed FET cycles was abnormal placental attachment, including placental adhesion and placenta increta (aOR 2.50, 95%CI 1.36-4.90). The dysfunction of placentation in programmed-FET cycles was independently associated with the type of infertility, the total dose of Femostone and thinner endometrium. Additionally, placental disorders in the programmed-FET group were associated with higher rate of preeclampsia, postpartum hemorrhage and Cesarean section.ConclusionOur retrospective study revealed that the programmed-FET has a substantial impact on placental development, resulting in a higher incidence of preeclampsia, postpartum hemorrhage and Cesarean section. These findings have significant implications on clinical decision-making.

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“…The National ART and Surrogacy Registry (NARTSR) has recorded similar growth in ART clinics and treatment in India [3]. Although many studies, mostly retrospective, have shown that pregnancies following ART are associated with increased third-stage complications like a prolonged third stage, retained placenta, adherent placenta, manual removal of placenta, postpartum hemorrhage (PPH), blood transfusion, and intensive care unit (ICU) admission [2,[4][5][6][7][8][9][10], it is unclear whether ART procedure, underlying infertility, or maternal antenatal factors are the reason behind these adverse third-stage outcomes. In vitro fertilization (IVF)-related factors like endometrium preparation and receptivity, ovarian stimulation, type of embryo (fresh/frozen), number of embryos transferred, and genetic alternation may also contribute to these adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Third-Stage Complications Among In Vitro Fertilization Pregnancies: An Observational Study

Magar,

Tejanaik,

Sagili

2024

Cureus

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Objective: This study aimed to determine the third-stage complications and their risk factors in in vitro fertilization (IVF) pregnancies. Methods: This prospective observational study was conducted from March 2022 to November 2023 at a tertiary care university hospital in South India. We included a total of 217 women following IVF conception, and details of the third-stage labor complications were documented and expressed as the frequency with percentage. The risk factors were analyzed using a logistic regression model. Results: Among 217 participants, 51 (23.5%) had third-stage complications. Postpartum hemorrhage (PPH) was the most common, complicating 20% of the deliveries. Multiple gestations (adjusted odds ratio (aOR) 2.7, 95% confidence interval (CI) 1.03-7.46, p = 0.04), operative vaginal delivery (aOR 57, 95% CI 4.2-770, p = 0.002), and emergency cesarean section (aOR 14.8, 95% CI 1.3-160.5, p = 0.026) were the risk factors for PPH. Intrapartum infection was found to be associated with a risk for the retained placenta (aOR 8, 95% CI 1.37-46.4, p = 0.02) and adherent placenta (aOR 6.06, 95% CI 1.07-34.3, p = 0.04). Assisted reproductive technology (ART)-related factors were not found to be significantly associated with third-stage complications. Conclusion: There is a risk of third-stage complications, especially postpartum hemorrhage, among IVF pregnancies. The type of embryo transfer was not associated with third-stage complications.

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Complications of the third stage of labor in in vitro fertilization pregnancies: an additional expression of abnormal placentation?

Cited by 11 publications

References 23 publications

Risk factors for retained placenta in a first pregnancy—A clinical trial

Risk factors for retained placenta in a first pregnancy—A clinical trial

Programmed frozen embryo transfer cycles are associated with a higher risk of abnormal placental development: a retrospective cohort study of singleton live births

Third-Stage Complications Among In Vitro Fertilization Pregnancies: An Observational Study

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