(878) Increased peripartum bleeding complications in very advanced maternal age patients who conceive via in-vitro fertilization

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Peripartum bleeding is a cause of severe maternal morbidity (SMM). In-vitro fertilization (IVF) is associated with hemorrhage risk factors, but is included in risk stratification. Very advanced maternal age patients (≥45 years at delivery) are more likely to require IVF. Our aim was to determine if vAMA patients who conceive with IVF are at increased risk of postpartum hemorrhage, blood transfusion, or unplanned hysterectomy compared to patients with non-IVF pregnancies.

Study Design: Retrospective cohort study of pregnant patients ≥45 years old delivering at a single institution (2014-2021, n = 430). Those with incomplete delivery records or higher order multiples were excluded. The primary exposure was in-vitro fertilization. Study outcomes included postpartum hemorrhage (PPH), blood transfusion, and unplanned hysterectomy. Differences analyzed by Fisher’s exact, χ² or t-test. Multivariable logistic regression was used to adjust for confounders found to be significantly different in univariable analysis. Significance set at α=0.05.

Results: Very advanced maternal age patients with IVF pregnancies have a 1.7-fold increased risk of peripartum bleeding complications (aOR 1.7, 95% CI [1.1-2.9], p = 0.03). Specifically, PPH was more likely in in-vitro vAMA pregnancies (aOR 2.4, 95% CI [1.1-5.1], p = 0.02). No unplanned hysterectomies were performed in vAMA patients with spontaneous pregnancies versus 11 in the IVF group (0.0 v. 3.7 percent, p = 0.04). Once controlling for mode of delivery, IVF was no longer associated with an increased risk of blood transfusion (OR 9.9, 95% CI [1.3-73.9], p = 0.03; aOR 7.5, 95% CI [1.0-58.2], p = 0.05).

Conclusion: In vAMA patients, IVF is associated with an increased risk of maternal morbidity due to peripartum bleeding. It may be reasonable to consider in-vitro fertilization as a risk factor for severe maternal morbidity. Additional research is needed to determine if it is due to the in-vitro fertilization procedure or the mechanism of infertility.

Primary & Presenting Author(s)

Rachel A. Newman, MBA, MD
Fellow
Cedars-Sinai Medical Center
Los Angeles, California, United States

Coauthor(s)

MN
Mariam Naqvi, MD
Assistant Professor, Obstetrics and Gynecology
Cedars-Sinai Medical Center
Los Angeles, California, United States
Candace Levian, MD
Resident
Cedars-Sinai Medical Center
Los Angeles, California, United States
Sarah Smithson, DO, MS
Cedars Sinai Medical Center
Los Angeles, California, United States
TE
Tania Esakoff, MD
Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology
Cedars-Sinai Medical Center
Los Angeles, California, United States