2018 Volume 32 Issue 2 Pages 169-177
Purpose
The authors' birth center is an in-hospital midwifery facility annexed to the Perinatal Medical Center. Even if the course of pregnancy and delivery is uneventful, unexpected massive bleeding can occur after childbirth. Pregnancies conceived via assisted reproductive technology (ART) are said to be a risk factor for placenta accreta; and placenta accreta can cause critical obstetrical hemorrhage. In our facility, if a parturient conceived via ART wishes to give birth in an in-hospital midwifery unit, childbirth is carried out in a birth center with the permission of the obstetrician. We conducted a case-control study about postpartum hemorrhage (PPH) to examine the safety of giving birth of pregnant women conceived via ART (fresh embryo transfer and cryopreserved embryo transfer) in an in-hospital midwifery care.
Subjects and Methods
During the survey period between April 2013 and March 2016, the total number of birth center deliveries was 604, including 567 not conceived through ART and 37 conceived through ART: fresh embryo transfer in 9 cases and cryopreserved embryo transfer (CET) in 28 cases. We carried out a statistical analysis of the amount of postpartum bleeding, the amount of bleeding during the 24 hours following delivery, and the frequency of PPH (postpartum bleeding of 500mL or more, or bleeding of 800mL or more during the 24 hours following delivery) among pregnancies not conceived through ART, pregnancies conceived through fresh embryo transfer, and pregnancies conceived through CET. Multiple linear regression analysis of the amount of postpartum bleeding and the amount of bleeding during the 24 hours following delivery was performed, and the frequency of PPH was determined using multivariate logistic analysis.
Results
The amount of postpartum bleeding and the amount during the 24 hours following delivery were significantly greater among pregnancies conceived through CET than among those not conceived through ART; the frequency of PPH was also significantly higher among pregnancies conceived through CET than among those not conceived through ART. In addition, PPH consisted of critical obstetrical hemorrhage in 4 cases, 3 of which occurred in mothers pregnant with fetuses conceived through ART using CET.
Conclusions
Our study suggested that pregnancy conceived through CET was a risk factor for PPH. Regarding care system and eligibility for giving birth of pregnant women conceived through CET in an in-hospital midwifery unit, further investigations are needed.
