Prevention of obstetric and perinatal complications in patients of advanced maternal age with pregnancy after ART

Authors

  • Oleg Golyanovskiy Shupyk National Healthcare University of Ukraine, Kyiv
  • Anna Rubinshtein Shupyk National Healthcare University of Ukraine, Kyiv

Keywords:

advanced maternal age, ART, vaginal delivery, cesarean section, gestational anemia, postpartum anemia, patient blood management, massive obstetric hemorrhage

Abstract

DOI: 10.52705/2788-6190-2022-01-8
УДК 618.17/.5-053.8:618.177-089.888.11:618.3/.7-06-084

The trend towards “aging” of motherhood, especially among women giving birth for the first time, has a worldwide spread. However, with age, there is a significant decrease in fertility and an increase in the need for assisted reproductive technologies (ART). Pregnancy and childbirth in advanced maternal age (AMA), as well as pregnancy and childbirth after ART, are associated with
a higher incidence of obstetric and perinatal complications; accordingly, the combination of these factors in one patient makes it possible to classify her as a high-risk group.
To prevent complications of pregnancy and delivery in AMA patients after ART, on the background of our own retrospective studies, current international guidelines and patient’s blood management recommendations we have formed an algorithm of pregnancy and delivery management in this contingent of women.
The objective: to determine the effectiveness of the proposed algorithm of pregnancy and delivery management in AMA patients after ART.
Materials and methods. The prospective study included 150 nulliparous AMA patients with a cephalic presentation, without severe somatic pathology, uterine anomalies and fetal congenital malformations.
3 groups were formed: the I (main) group – 50 ART patients, pregnancy and delivery were carried out according to the above algorithm; the IІ (comparison) group – 50 patients after ART, and the III (control) group – 50 patients with spontaneous pregnancy, pregnancy and delivery in the second and third groups were carried out in accordance with the current protocols of the
Ministry of Health of Ukraine.
For the statistical analysis, the odds ratios and the 95% confidence interval were calculated. The significance of the difference was determined using Student’s t-test for continuous variables and chi-square tests and Fisher’s exact test for categorical variables. The level of statistical significance was set at p<0.05.
Results. The frequency of normal delivery in the main group did not differ from the comparison group and the control group. The average blood loss during vaginal delivery in the main group was 263.04±10.8 ml, it was significantly less than the average blood loss in the comparison group (328.5±19.17 ml; p1,2<0.05) and did not significantly differ from the same indicator in the control
group (273.71±10.23 ml; p1,3>0.05). The frequency of caesarian section (CS) did not differ significantly between the study groups.
However, the proportion of urgent CS in the main group was 52% and it was significantly lower than in the comparison group and in the control group (p1,2,3<0.05). The structure of indications for urgent CS did not differ significantly (p1,2,3>0.05). The average blood loss after CS in the main group was 686.67±17.05 ml, and was significantly less than this indicator in the comparison group (813.67±47.26 ml; p1,2<0.05) and significantly did not differ from the same indicator in the control group (695.33±29.32 ml; p2,3>0.05).
At terms of 35-37 weeks, gestational anemia complicated pregnancy in 2% of patients from the main group compared with 30% of patients from the comparison group and 18 % of patients from the control group (p1,2; p1,3<0.05). Anemia in 8 weeks after delivery was diagnosed in 2% of patients in the main group, 56% of patients in the comparison group and 44% of patients in the control
group (p1,2<0.01; p1,3<0.05). The average length of hospital stay after delivery was 4.08±0.19 days in the main group, it was significantly less than in the comparison group (p1,2<0.05), and did not differ significantly from the control group.
Conclusions. Additional determination of ferritin concentration during pregnancy and timely correction of latent iron deficiency in AMA patients after ART significantly reduced the likelihood of manifestations of gestational and postpartum anemia and, accordingly, associated complications, and did not lead to excessive intake of iron supplements. Replacing the induction of labor at term of 40–41 weeks of gestation with a planned CS in AMA patients after ART in case of the spontaneous onset of regular labor absence, did not lead to an increase of the overall frequency of pathological deliveries and operations, it can significantly
reduce the number of urgent CS and transfer them to the planned one. The prophylactic use of carbetocin and tranexamic acid a combination immediately after the umbilical cord transection in this patients significantly reduced the volume of blood loss and made it possible to reduce the frequency of massive obstetric hemorrhages, thus reducing the proportion of postpartum complications, including anemia.

Author Biographies

Oleg Golyanovskiy, Shupyk National Healthcare University of Ukraine, Kyiv

Department of Obstetrics and Gynecology №1 of Shupik National Healthcare University of Ukraine, Kyiv; tel.: (044) 489-35-64, (067) 741-77-68.

Anna Rubinshtein, Shupyk National Healthcare University of Ukraine, Kyiv

Department of Obstetrics and Gynecology №1 of Shupik National Healthcare University of Ukraine, Maternity Hospital «Leleka», Kyiv; tel: (044) 334-72-08, (066) 005-88-81.

Published

07.04.2022

How to Cite

1.
Голяновський О, Рубінштейн А. Prevention of obstetric and perinatal complications in patients of advanced maternal age with pregnancy after ART. par [Internet]. 2022 Apr. 7 [cited 2022 Jun. 27];2(1):83-95. Available from: http://par.org.ua/index.php/par/article/view/67