Analysis of delivery in singleton pregnancies achieved by in vitro fertilization

Abstract

BACKGROUND: Birth after in vitro fertilization (IVF) is increasingly observed in modern obstetrics, so knowledge of its features is of paramount importance for clinical practice. AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of cesarean section rate, operative vaginal birth rate, induction of labor, manual removal of the placenta in vaginal births, severe postpartum hemorrhage (PPH), and need for blood transfusion after delivery. MATERIAL AND METHODS: We conducted a retrospective study at “Maichin Dom” University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies. RESULTS: We found a significantly higher rate of cesarean sections in IVF compared to spontaneous pregnancies (OR 1.73; 95% CI 1.4–2.14; p < 0.001). Vaginal delivery after IVF is associated with a higher incidence of operative vaginal delivery than spontaneous pregnancies (OR 2.27; 95% CI 1.14–4.52; p = 0.018). No statistical differences in rates of labor induction and manual removal of the placenta between the two groups were estimated (p > 0.05). Severe PPH and blood transfusions were three times higher in patients after IVF undergoing a cesarean section than in those with spontaneous singleton pregnancies (OR 3.0; 95% CI 1.11–8.11; p = 0.018). CONCLUSION: IVF singleton pregnancies are associated with a higher risk of cesarean section as well as some obstetric complications. Obstetricians should treat these pregnancies with caution in order to reduce cesarean section rate and improve the outcome.