Risk Factors for Postpartum Hemorrhage in Vaginal Deliveries: Assisted Reproductive Technology Pregnancies versus Spontaneous Conceptions.

doi:10.3877/cma.j.issn.2095-3259.2025.03.007

Abstract

Abstract:

Objective

To compare the differences in risk factors of postpartum hemorrhage (PPH) between patients conceiving via assisted reproductive technology (ART) and spontaneous conception, and to explore whether ART conception is an independent risk factor for PPH.

Methods

A retrospective cohort study was conducted involving 25 035 women aged 18-49 years with singleton vaginal deliveries at Peking University Third Hospital from January 2012 to December 2020. They were divided into ART group (2 003 cases, accounting for 8.0%) and natural pregnancy group (23 032 cases, accounting for 92.0%) based on whether ART conception occurred. The maternal age, gestational age at delivery, primiparous status, body mass index (BMI), pregnancy complications (pregnancy anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, macrosomia and placenta accreta spectrum) of the two groups were analyzed respectively. Chi-square and Mann-Whitney U tests were used to verify the correlation between ART and the incidence of PPH and blood loss. Furthermore, multivariate logistic regression was conducted.

Results

The incidence of PPH in the ART group and non-ART group was 19.4% and 11.9%, respectively (P<0.001). After removing the confounding factors such as maternal age (34 years vs 31 years, P<0.001), gestational age (39 weeks vs 39 weeks, P=0.924), primiparous status (91.4% vs 76.7%, P<0.001), body mass index (BMI) (21.631 kg/m² vs 21.077 kg/m^2, P<0.001), pregnancy complications [pregnancy anemia (5.5% vs 6.0%, P=0.410), hypertensive disorders in pregnancy (8.0% vs 5.9%, P<0.001), gestational diabetes mellitus (33.5% vs 21.9%, P<0.001), macrosomia (3.1% vs 3.4%, P=0.482) and placenta accreta spectrum (4.0% vs 2.4%, P<0.001)], the incidence of PPH (OR=1.580, 95%CI: 1.382~1.806, P<0.001) and blood loss (β=47.526, 95%CI: 7.051~88.001, P=0.021) in the ART group was significantly higher than that in the non-ART group.

Conclusions

Compared with spontaneous conception, ART conception is associated with an increased risk of PPH during vaginal delivery, highlighting the need for enhanced risk management in ART pregnancies.

Key words: Postpartum hemorrhage, Assisted reproduction technology, Parturition, Vagina

Jiangxue Qu, Shuangyi Liang, Yuan Wei, Huifeng Shi, Yangyu Zhao. Risk Factors for Postpartum Hemorrhage in Vaginal Deliveries: Assisted Reproductive Technology Pregnancies versus Spontaneous Conceptions.[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2025, 14(03): 161-166.

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URL: https://zhckjjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3259.2025.03.007

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References 23

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组别	例数	年龄[岁，M(P₂₅～P₇₅)]	分娩孕周[周，M(P₂₅～P₇₅)]	初产[例数(%)]	BMI[kg/m^2, M(P₂₅～P₇₅)]
ART	2 003	34(32, 36)	39(38, 40)	1 830(91.4)	21.631(20.069, 23.875)
非ART	23 032	31(29, 33)	39(38, 40)	17 671(76.7)	21.077(19.487, 23.047)
统计值		Mann-Whitney U＝32 917 789.000	Mann-Whitney U＝34 924 795.000	χ²＝229.641	Mann-Whitney U＝22 491 421.500
P值		<0.001	0.924	<0.001	<0.001

组别	例数	年龄[岁，M(P₂₅～P₇₅)]	分娩孕周[周，M(P₂₅～P₇₅)]	初产[例数(%)]	BMI[kg/m^2, M(P₂₅～P₇₅)]
ART	2 003	34(32, 36)	39(38, 40)	1 830(91.4)	21.631(20.069, 23.875)
非ART	23 032	31(29, 33)	39(38, 40)	17 671(76.7)	21.077(19.487, 23.047)
统计值		Mann-Whitney U＝32 917 789.000	Mann-Whitney U＝34 924 795.000	χ²＝229.641	Mann-Whitney U＝22 491 421.500
P值		<0.001	0.924	<0.001	<0.001

组别	例数	妊娠期贫血	HDP	GDM	巨大胎儿	胎盘植入
ART	2 003	111(5.5)	160(8.0)	671(33.5)	62(3.1)	81(4.0)
非ART	23 032	1 381(6.0)	1 354(5.9)	5 049(21.9)	781(3.4)	543(2.4)
χ²值		4.674	14.429	140.134	0.495	21.562
P值		0.410	<0.001	<0.001	0.482	<0.001

组别	例数	妊娠期贫血	HDP	GDM	巨大胎儿	胎盘植入
ART	2 003	111(5.5)	160(8.0)	671(33.5)	62(3.1)	81(4.0)
非ART	23 032	1 381(6.0)	1 354(5.9)	5 049(21.9)	781(3.4)	543(2.4)
χ²值		4.674	14.429	140.134	0.495	21.562
P值		0.410	<0.001	<0.001	0.482	<0.001

组别	例数	发生率[例(%)]	出血量[ml, M(P₂₅～P₇₅)]
ART	2 003	389(19.4)	260(200, 300)
非ART	23 032	2 743(11.9)	200(200, 300)
统计值		χ²＝94.988	Mann-Whitney U＝512 414.0
P值		<0.001	<0.001

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