Features of pregnancy, delivery and postpartum on the background of assisted reproductive technologies
Authors: Golyanovskiy О.V. , Zukin V.D. , Shemyakina N.M. , Rubinshtein A.M. 
Published: May 2022

The objective: to establish the characteristics of the course of pregnancy and childbirth after the use of assisted reproductive technologies (ART); to stratify the risks in this contingent of pregnant women, to determine the high-risk subgroup among pregnant women after the use of ART and the formation of possible preventive approaches for these categories of patients. Materials and methods. A retrospective analysis of 3450 histories of pregnancy and childbirth that occurred during 2018–2020, was carried out. Inclusion criteria: first singleton delivery in cephalic presentation without critical congenital malformations in the fetus and severe somatic pathologies in pregnant women aged 18–45 years. Two groups were formed: a group with spontaneous pregnancy (3137 histories) and a group with pregnancy after ART (313 histories), which, according to the age factor, were divided into subgroups of active (2686 and 159 histories, respectively) and late reproductive age (451 and 154 histories, respectively).For statistical analysis, odds ratio (OR) and 95% confidence interval (CI) were calculated. The χ-square test was used to assess the significance of the difference in proportions. The level of statistical significance was at p<0.05.Results. The frequency of normal births in the subgroup of late reproductive age with pregnancy after the use of ART was 38.8%, that almost 2 times lower than in the subgroup of spontaneous pregnancy in women of late reproductive age (65.5%; p<0.05). Patients with late reproductive age and pregnancy after using ART (28.5%) had two times higher chances of induction of labor compared with the spontaneous pregnancy subgroup (14.3%; p<0.05). The incidence of cesarean section was 51.1% in the ART subgroup compared to 27% in the spontaneous pregnancy subgroup (p<0.05). In the subgroup of late reproductive age and pregnancy after ART, the probability of cesarean section was in 1.7 times higher than in the subgroup of active reproductive age and pregnancy after ART. The risks of developing massive obstetric bleeding in patients with late reproductive age and pregnancy after ART were in 5.5 times higher than in patients with spontaneous pregnancy (p<0.05) and 2.8 times higher than in patients of active reproductive age and pregnancy after ART. The rate of normal induced labor in the ART group in women under 35 years of age was 51.7%, while in the subgroup of late reproductive age patients with pregnancy after ART, this indicator decreased to 23.5%. The incidence of unsuccessful induction of labor in patients with late reproductive age and pregnancy after ART was 19.6%, the frequency of cesarean section after induced labor in the subgroup of late reproductive age and pregnancy after ART was 70.6%. The likelihood of the massive obstetric bleeding development during induced labor in patients with late reproductive age and pregnancy after ART was in 5 times higher than in spontaneous pregnancy in this age subgroup (OR 5.05; 95% CI: 0.94-27.05) and 6.8 times higher than in the subgroup of active reproductive age after the use of ART (OR 6.84; 95% CI: 2.2-21.24). The newborns conceived after ART and after induced labor had in 2.8 times greater risks of the necessity for primary neonatal resuscitation.Conclusions. The pregnancy and labor after ART were characterized by a higher incidence of preterm birth, caesarean section, assisted vaginal delivery, and massive obstetric bleeding. The rate of complications significantly increased in women of late reproductive age. For patients with pregnancy after the use of ART, it is advisable to conduct labor using continuous cardiotocography monitoring, timely correction of labor abnormalities according to the partogram, the use of modern effective algorithms for the prevention of obstetric bleeding. For the pregnant women of late reproductive age after ART in the absence of spontaneous onset of regular labor, we recommend to consider the possibility of a planned caesarean section at 40–41 weeks of gestation.