Is There an Association Between Pregnancies Conceived Through Assisted Reproductive Technologies and Time and Complications of the Third Stage of Labor? [164]

INTRODUCTION: To determine whether vaginal deliveries exposed to assisted reproductive technologies (ARTs) are associated with an increased time between delivery of the neonate and placenta and select complications. Whether these risks are attributable to method of ART or are intrinsic to infertile populations is unknown. Assisted reproductive technologies are known risk factors for abnormal placentation. METHODS: A retrospective cohort of patients in an infertility practice who went on to have term, singleton, vaginal deliveries at two hospitals from 2008 to 2013 were analyzed. The control group consisted of patients with spontaneous conceptions after infertility consultations. Exposure groups were patients with controlled ovarian hyperstimulation with in vivo fertilization, controlled ovarian hyperstimulation with in vitro fertilization and fresh embryo transfer, and frozen embryo transfer or oocyte donation recipients in whom the endometrium was not exposed to controlled ovarian hyperstimulation. Multiple gestations and stillbirths were excluded. The median time of the third stage of labor was compared using the Mann-Whitney U test. Secondary outcomes of retained placenta (time greater than 30 minutes), manual placental extraction, and postpartum hemorrhage (estimated blood loss greater than 500 g or using uterotonics) were compared using the χ2 or Fisher's exact analyses. RESULTS: A total of 769 patients met criteria. There were no differences in time of the third stage of labor, retained placenta, and postpartum hemorrhage between the exposure and control groups. Manual extraction was significantly more common among frozen embryo transfer (age-adjusted odds ratio 5.6, 95% confidence interval 2.2–13.8; P<.001). CONCLUSION: Patients who conceived after frozen embryo transfer were at increased risk for manual placental extraction. This association was not influenced by age differences between groups.