IVF is an Independent Risk Factor for Third Stage of Labor Complications Following Successful Vaginal Deliveries - Israeli Fertility Association Conference-Ayala 2017, May 8-9, 2017

Sharon Oron ^1,2 Eran Ashwal ^2,4 Onit sapir ¹ Galia Oron ^1,2 Haim Pinkas ^1,2 Avi Ben-Haroush ^1,2 Tzippy Shochat ³ Arnon Wiznitzer ^2,5 Benjamin Fisch ^1,2 Yoel Shufaro ^1,2

¹Infertility and IVF Unit, Beilinson Women's Hospital- Rabin Medical Center
²The Sackler Faculty of Medicine, Tel Aviv University
³Research Authority, Beilinson Hospital- Rabin Medical Center
⁴Lis Maternity and Women’s Hospital, Tel-Aviv Sourasky Medical Center
⁵Beilinson Women's Hospital- Rabin Medical Center, Beilinson Women's Hospital- Rabin Medical Center

Introduction: IVF pregnancies are associated with more perinatal complications than spontaneous gestations, even after correction of confounding factors. Little is known about the prevalence of third stage of labor complications in IVF pregnancies, excluding higher prevalence of placenta accreta reported in few small studies.

Aim: To determine if third stage of labor complications are more prevalent in singleton vaginal deliveries following IVF gestations than in matched spontaneous control gestations.

Materials & Methods: Cohort study reviewing delivery files of all our IVF patients who vaginally delivered singletons in Beilinson hospital between 8/2011-3/2014. The study group consisted of 242 IVF gestations, and 484 matched spontaneous pregnancy controls based on age, gravidity, parity and week of delivery. The impact of pregnancy type on the length and complications of the third stage of labor was examined.

Results: The length of the third stage was similar in IVF deliveries and controls (14.23±8.89 and 13.69±9.19 minutes respectively). The rated of post-partum hemorrhage was 5.79% in IVF deliveries and 1.45% in controls (p=0.001). Manual lysis was performed in 11.98% of the IVF deliveries and in 7.02% of the controls (p=0.025). Blood transfusion was required in 2.07% of the IVF deliveries and in 0.41% of the controls (p=0.032). Abnormally adherent placenta was diagnosed in 2 deliveries following IVF (0.83%) and none of the controls (p=0.045).

Conclusions: After correction for confounders, IVF is an independent risk factor for post-partum hemorrhage, requirement for manual lysis and blood transfusions. Therefor complication anticipating management of the third stage is warranted in women delivering vaginally following IVF pregnancies, even in the absence of other risk factors.