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The effect of assisted reproductive technology (ART) on the amount of bleeding during delivery under epidural analgesia
Abstract Number: F-42
Abstract Type: Original Research
Assisted reproductive technology (ART) has been widely used to treat infertility. Recently, increasing numbers of women who conceived through ART have requested labor epidural analgesia. However, there are few reports investigating the relationship between the amount of bleeding and ART procedures. Thus, we conducted this retrospective study to investigate whether the amount of bleeding in ART cases is more than those spontaneously conceived.
This study was approved by the Institutional Review Board of Hamamatsu University Hospital (E16-219). We retrospectively investigated medical records of primiparas with singleton pregnancies who delivered under epidural analgesia at our hospital from 2005 to 2015. We compared the data between women conceived with ART (Group A [n=30]) and without ART (Group B [n=194]). Furthermore, we compared the amount of bleeding in deliveries between methods of ART (IVF-ET, frozen-thawed embryos transferred (FET) during either natural or hormonal cycle). Statistical analysis was performed using unpaired t-test or Mann-Whitney test for continuous variables depending on the sample distribution, and chi-square test for categorical data. The amount of bleeding was analyzed by one-way analysis of variance.
There were significant differences in age (Group A 36.8 ± 4.2, Group B 31.8 ±4.6 ; p=0.000) and the amount of bleeding in delivery (Group A 1264.0 ± 1222.5 ml, Group B 791.8 ± 454.4 ml ; p=0.005). There was still significant difference after an analysis of covariance to remove the influence of age (p=0.0025). The percentage of patients with the amount of bleeding more than 1,000ml was significantly high in Group A (Group A 43.3% vs. Group B 23.1% ; p=0.019). Among 13 cases of bleeding more than 1,000ml in Group A, we found uterine atony in 4 cases, placental acreta in 2 cases, cervical laceration in one case, and the etiology was not clear in remaining 6 cases. There were no significant differences in height, weight, duration of delivery, rate of instrumental delivery, weight of the babies or umbilical cord blood pH. The methods of embryo transfer were revealed in 22 cases in Group A (IVF-ET in 4 cases, natural cycle-FET in 3 cases, and hormonal cycle-FET in 15 cases). The amounts of bleeding were 968.8 ± 432.8 ml, 431.7 ± 256.2 ml, 1208.3 ± 437.0 ml, respectively. We found significant difference between natural cycle-FET and hormonal cycle-FET; p=0.034.
The results of this study suggest that careful postpartum management is recommended to the pregnant women who conceived with ART. The result that amount of bleeding was more in women with FET during hormonal cycle is consistent with previous report1). We should collect more cases and consider the point.