Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia
Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia
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DOI：
10.1093/humrep/dep376
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发表时间：
2010-01-01
影响因子：
6.1
通讯作者：
Baker, H. W. G.
中科院分区：
文献类型：
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作者：
Healy, D. L.;Breheny, S.;Baker, H. W. G.
据报道，辅助生殖技术(ART)后产科出血增加，但其中涉及的机制尚不清楚。这项回顾性队列研究比较了1991至2004年间澳大利亚维多利亚州单胎生育妇女产前出血(APH)、前置胎盘(PP)、胎盘早剥(PA)和原发产后出血(PPH)的发生率：不孕症患者中，IVF/ICSI后6730例，普通人群24619例，配子内移植(GIFT)后779例，以及非ART受孕2167例。经Logistic回归分析，IVF/ICSI组的APH：6.7比3.6%(调整后OR 2.0；95%CI 1.8-2.3)，PP：2.6比1.1%(2.3；1.9-2.9)，PA：0.9比0.4%(2.1；1.4-3.0)，PPH：11.1比7.9%(1.3；1.2-1.4)。APH、PP和PA在GIFT组与IVF/ICSI组相同，但在非ART组较少。在IVF/ICSI组中，新鲜胚胎移植(FET)与冷冻解冻胚胎移植(FET)相比，APH(1.5；1.2-1.8)和PA(2.1；1.2-3.7)的发生率更高，优势比(OR)随着采集的卵母细胞数量的增加而增加(1.02；1.00-1.04)。子宫内膜异位症患者的PP(1.7；1.2~2.4)和PPH(1.3；1.1~1.6)均高于非子宫内膜异位症患者。与自然周期中的FET相比，人工周期中的FET与PPH(1.8；1.3-2.6)有关，单胎IVF、ICSI和GIFT后产科出血的发生率更高。对IVF/ICSI组因素的探索性分析表明，在刺激周期中进行新鲜胚胎移植、子宫内膜异位症和激素治疗与新鲜胚胎移植有关，可能与植入时发生的事件有关，子宫内膜功能不佳是关键机制。
Obstetric haemorrhages have been reported to be increased after assisted reproduction technologies (ART) but the mechanisms involved are unclear.This retrospective cohort study compared the prevalence of antepartum haemorrhage (APH), placenta praevia (PP), placental abruption (PA) and primary post-partum haemorrhage (PPH) in women with singleton births between 1991 and 2004 in Victoria Australia: 6730 after IVF/ICSI, 24 619 from the general population, 779 after gamete intrafallopian transfer (GIFT) and 2167 non-ART conceptions in infertile patients. Risk factors for haemorrhages in the IVF/ICSI group were examined by logistic regression.The IVF/ICSI group had more APH: 6.7 versus 3.6% (adjusted OR 2.0; 95% CI 1.8-2.3), PP: 2.6 versus 1.1% (2.3; 1.9-2.9), PA: 0.9 versus 0.4% (2.1; 1.4-3.0) and PPH: 11.1 versus 7.9% (1.3; 1.2-1.4) than the general population. APH, PP and PA were as frequent in the GIFT group as in the IVF/ICSI group, but were less frequent in the non-ART group. Within the IVF/ICSI group, fresh compared with frozen thawed embryo transfers (FET) was associated with more frequent APH (1.5; 1.2-1.8) and PA (2.1; 1.2-3.7) and the odds ratio increased with number of oocytes collected (1.02; 1.00-1.04). Endometriosis patients had more PP (1.7; 1.2-2.4) and PPH (1.3; 1.1-1.6) than those without endometriosis. FET in artificial cycles was associated with increased PPH (1.8; 1.3-2.6) compared with FET in natural cycles.Obstetric haemorrhages are more frequent with singleton births after IVF, ICSI and GIFT. The exploratory analysis of factors in the IVF/ICSI group, showing associations with fresh embryo transfers in stimulated cycles, endometriosis and hormone treatments, suggests that events around the time of implantation may be responsible and that suboptimal endometrial function is the critical mechanism.