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

TL;DR

This study found that about a quarter of IVF pregnancies face third-stage complications, with postpartum hemorrhage being the most common.

Contribution

The study identifies specific risk factors for third-stage complications in IVF pregnancies, such as multiple gestations and operative deliveries.

Findings

23.5% of IVF pregnancies experienced third-stage complications, with postpartum hemorrhage being the most common.

Multiple gestations and operative vaginal delivery significantly increased the risk of postpartum hemorrhage.

Intrapartum infection was linked to retained and adherent placenta, but ART factors were not significant.

Abstract

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.