Assisted reproductive technology and severe postpartum haemorrhage: a case-control study

Objectives: Whether there is a link between assisted reproductive technology (ART) and brain damage in premature infants remains unclear. The aim of this study was to determine whether premature infants conceived by ART are at a greater risk of developing white matter injury (WMI), as detected by magnetic resonance imaging (MRI) or diffusion-weighted imaging (DWI) within 14 days, than those naturally conceived (NC).Methods: A retrospective case-control study was conducted on singleton premature infants with a gestational age of ≥28 weeks and <34 weeks delivered between 2017 and 2019 at Shengjing Hospital, China Medical University. This study included 638 live births that were stratified into case group (n = 218) and control group (n = 420), depending on the presence or absence of WMI. The exposure proportion of ART was compared between the case and control groups, and a logistic regression model was used to identify whether ART was an independent risk factor for WMI.Results: In the univariate analysis, the exposure proportion of ART conception was higher in cases than in controls (12.84 vs. 7.38%, p = 0.024). According to the multivariable analysis, after adjustment for other variables, the association between ART and WMI remained significant (1.82; 95% confidence interval, 1.04–3.21; P = 0.038).Conclusions: Singleton premature infants conceived by ART have a higher risk of WMI than NC infants. Given that ART is an independent risk factor for WMI in premature infants, more attention should be paid to neurodevelopmental outcomes in this group.

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Investigating and modelling risk factors for primary postpartum haemorrhage among childbearing Women in the Northern Province of Rwanda: A Case Control Study

10.21203/rs.3.rs-222735/v1 ◽

2021 ◽

Author(s):

Oliva Bazirete ◽

Manassé Nzayirambaho ◽

Aline Umubyeyi ◽

Innocent Karangwa ◽

Marilyn Evans

Keyword(s):

Risk Factors ◽

Postpartum Haemorrhage ◽

Fetal Death ◽

Case Control Study ◽

Prediction Models ◽

Multiple Pregnancy ◽

Case Control ◽

Uterine Atony ◽

Antepartum Haemorrhage ◽

Control Study

Abstract Background: The vast majority of maternal deaths occur in Low- and Middle-Income Countries. Postpartum haemorrhage (PPH) remains a major global burden contributing to high maternal mortality and morbidity rates. Assessment of PPH risk factors should be undertaken during antenatal, intrapartum and postpartum periods for timely prevention of maternal morbidity and mortality associated with PPH. The aim of this study is to investigate and model risk factors for primary PPH in Rwanda. Methods: We conducted an observational case-control study of 430 (108 cases: 322 controls) pregnant women with gestational age of 32 weeks and above who gave birth in five selected health facilities of Rwanda between January and June 2020. Poisson regression, a generalized linear model with a log link and a Poisson distribution was used to estimate the risk ratio of factors associated with PPH. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Institutional Ethics Review Board. Results: The overall prevalence of primary PPH was 25.2%. The following risk factors were identified: antepartum haemorrhage (RR=3.36; 95% CI 1.80- 6.26, P<0.001); intrauterine fetal death (RR=1.93; 95% CI 0.93- 4.03, P<0.077); multiple pregnancy (RR=1.83; 95% CI 1.11- 3.01, P=0.016); haemoglobin level <11 gr/dL (RR=1.51; 95% CI 1.00- 2.30, P=0.050), and premature rupture of membranes (RR=0.58; 95% CI 0.32- 1.05, P<0.077). During the intrapartum and immediate postpartum period, the main causes of primary PPH were: uterine atony (RR=6.70; 95% CI 4.78- 9.38, P<0.001), retained tissues (RR= 4.32; 95% CI 2.87- 6.51, P<0.001); and lacerations of genital organs after birth (RR= 2.14; 95% CI 1.49- 3.09, P<0.001). Coagulopathy was not prevalent in primary PPH. Conclusion: Based on our findings, uterine atony remain the foremost cause of primary PPH. As well as other established risk factors for PPH, antepartum haemorrhage and intra uterine fetal death should be included as risk factors in the development and validation of prediction models for PPH. Large scale studies are needed to investigate further potential PPH risk factors.

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