辅助生殖技术与第三产程延长：日本的一项多中心研究

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online Pub Date : 2024-07-22 DOI:10.1016/j.rbmo.2024.104382

Akihito Kato , Takafumi Ushida , Seiko Matsuo , Sho Tano , Kenji Imai , Shigeru Yoshida , Mamoru Yamashita , Hiroaki Kajiyama , Tomomi Kotani

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引用次数: 0

摘要

研究问题与产后出血密切相关的第三产程延长的风险因素是什么，以及辅助生殖技术（ART）对第三产程的影响是什么？设计获得了在日本12家基层妇产医院经阴道分娩的足月产妇的临床数据（2010-2018年）（n = 25336）；其中1148人（4.5%）通过ART受孕，2246人（8.9%）通过非ART治疗受孕。通过单变量和多变量回归分析评估了第三产程延长（定义为≥20分钟）的风险。结果多变量分析显示，通过抗逆转录病毒疗法怀孕（aOR 4.38，95% CI 3.12-6.15）、自然流产史（OR 1.40，95% CI 1.06-1.84）和产程延长（OR 1.52，95% CI 1.09-2.12）被认为是独立的风险因素。冷冻胚胎移植（FET）、激素替代周期中的 FET（HRC-FET）和囊胚期胚胎移植与第三产程延长有显著相关性（分别为 aOR 4.07，95% CI 2.75 至 6.04；aOR 4.11，95% CI 2.58 至 6.57；aOR 2.13，95% CI 1.15 至 3.95）。结论通过抗逆转录病毒疗法（尤其是 FET、HRC-FET 和囊胚期胚胎移植）怀孕是导致第三产程延长的重要风险因素。

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Assisted reproductive technology and prolonged third stage of labour: a multicentre study in Japan

Research question

What are the risk factors for a prolonged third stage of labour, closely related to postpartum haemorrhage, and what is the effect of assisted reproductive technology (ART) on the third stage of labour?

Design

Clinical data of women who delivered vaginally at term at 12 primary maternity hospitals in Japan (2010–2018) (n = 25,336) were obtained; 1148 (4.5%) conceived through ART and 2246 (8.9%) through non-ART treatments. The risk of a prolonged third stage of labour (defined as ≥20 min) was evaluated by univariable and multivariable regression analyses. Adjusted odds ratios (aOR) of a prolonged third stage of labour were evaluated, stratified by the type of ART, with natural conception as a reference.

Results

Multivariable analysis showed that pregnancy achieved through ART (aOR 4.38, 95% CI 3.12 to 6.15), history of spontaneous miscarriage (OR 1.40, 95% CI 1.06 to 1.84) and prolonged labour (OR 1.52, 95% CI 1.09 to 2.12) were identified as independent risk factors. Frozen embryo transfer (FET), FET in a hormone replacement cycle (HRC–FET) and blastocyst-stage embryo transfer were significantly associated with a prolonged third stage of labour (aOR 4.07, 95% CI 2.75 to 6.04, aOR 4.11, 95% CI 2.58 to 6.57 and aOR 2.13, 95% CI 1.15 to 3.95, respectively). No significant difference was observed in the duration of third stage of labour between natural conception and non-ART treatment (P = 0.61).

Conclusion

Pregnancy achieved through ART, particularly FET, HRC–FET and blastocyst-stage embryo transfer, was a significant risk factor for a prolonged third stage of labour.

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来源期刊

Reproductive biomedicine online 医学-妇产科学

CiteScore

7.20

自引率

7.50%

发文量

391

审稿时长

50 days

期刊介绍： Reproductive BioMedicine Online covers the formation, growth and differentiation of the human embryo. It is intended to bring to public attention new research on biological and clinical research on human reproduction and the human embryo including relevant studies on animals. It is published by a group of scientists and clinicians working in these fields of study. Its audience comprises researchers, clinicians, practitioners, academics and patients. Context: The period of human embryonic growth covered is between the formation of the primordial germ cells in the fetus until mid-pregnancy. High quality research on lower animals is included if it helps to clarify the human situation. Studies progressing to birth and later are published if they have a direct bearing on events in the earlier stages of pregnancy.