Skip to main content
ISTH 2023 Main banner
Back

    Oral Communication

    Women’s Health

    Bleeding and Neonatal Alloimmune Thrombocytopenia in Pregnancy

    OC 02.3 - Risk factors for severe postpartum hemorrhage after assisted reproductive technology: data from the French HEMOTHEPP cohort study

    Saturday, June 24, 2023
    13:30 – 13:45 ET
    Room: 710A
    Session Available As: Live-Stream and On-Demand

      Presenting Author(s)

    • Sara Robin, MD (she/her/hers)

      INSERM U1304-GETBO, Université de Bretagne Occidentale, FCRIN INNOVTE, Brest, France
      Brest, Bretagne, France

      • Co-Author(s)

    • SB

      Sarah Bouée

      MD
      Département d’Assistance Médicale à la Procréation au sein du Service de Gynécologie Obstétrique, CHU Brest, 29200 Brest, France
      Brest, Bretagne, France

    • FA

      François Anouilh

      Enseignant en maïeutique
      Ecole universitaire de maïeutique de Brest, UFR Santé, 29200 Brest, France
      Brest, Bretagne, France

    • CT

      Christophe Trémouilhac

      MD
      Obstetrics and Gynecology ward, Brest University Hospital
      BREST, Bretagne, France

    • GD

      Guillaume Drugmanne

      TEC
      CIC1412, INSERM - Brest (France), France
      Brest, Bretagne, France

    • ML

      Mathilde Le Guillou

      MD
      Département d’Assistance Médicale à la Procréation au sein du Service de Gynécologie Obstétrique, CHU Brest, 29200 Brest, France
      Brest, Bretagne, France

    • AB

      Antoine Blin

      MD
      Département d’Assistance Médicale à la Procréation, Clinique Keraudren, 29200 Brest, France
      Brest, Bretagne, France

    • VB

      Violaine Bellec

      MD
      Cabinet de Gynécologie Obstétrique, Clinique Keraudren, 29200 Brest, France
      Brest, Bretagne, France

    • MM

      Matthieu Muller

      MD
      Service de Gynécologie Obstétrique, Centre Hospitalier des Pays de Morlaix, 29600, Morlaix, France
      Morlaix, Bretagne, France

    • MJ

      Matthieu Jacquot

      MD
      Service de Gynécologie Obstétrique, Centre Hospitalier de Cornouailles, 29000 Quimper, France
      Quimper, Bretagne, France

    • CT

      Cecile Tromeur

      MD, PhD
      Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
      Brest, Bretagne, France

    • Francis Couturaud, PhD (he/him/his)

      MD, PhD
      Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
      Brest, Bretagne, France

    • EL

      Emmanuelle Le Moigne

      MD
      INSERM U1304-GETBO, Univ Brest, FCRIN INNOVTE, Brest, France
      Brest, Bretagne, France

    • BP

      Brigitte Pan-Petesch

      MD
      CRC-MHC Brest – Service Hématologie, Unité Hémostase Clinique
      BREST, Bretagne, France

    • Claire de Moreuil, MD,PhD (she/her/hers)

      Hospital Practioner in Internal Medicine
      Internal medicine and Pneumology Department, Brest University Hospital, UMR 1304, GETBO
      BREST, Bretagne, France

    Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbi-mortality. The increasing incidence of pregnancies following assisted reproductive technology (ART) is a matter of concern regarding the potential association between ART and PPH.

    Aims: To determine the risk for severe PPH (sPPH) in pregnancies obtained by ART according to type of procedure.

    Methods: HEMOTHEPP is a prospective multicentric cohort study who took place in all maternities of Finistère, a French county. All pregnant women admitted for delivery after ≥15 weeks of gestation were asked to participate. Conception was classified as natural or obtained by ART (ie ovulation induction (OI), intra-uterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and oocyte or embryo donation). sPPH was objectively measured and defined as a blood loss ≥ 1000 mL within the 24 hours following delivery. Independent risk factors for sPPH were identified by a multivariate logistic regression model. The study was approved by the West Central Independent Ethics Committee and all participants provided informed consent.

    Results: 20 075 deliveries were included between June 1, 2015 and January 31, 2019. Conception was obtained by ART in 943 (4.9%) pregnancies, with 24 (2.5%) oocyte donations, 558 (59%) IVF/ICSI, 159 (17%) IUI and 202 (21%) OI (Figure 1). sPPH occurred more frequently in the ART group than in controls (4.7% versus 1.9%, p< 0.001) whatever the ART procedure, with respectively 12% in the oocyte donation, 5.6% in the IVF/ICSI, 3.1% in the IUI and, 2.5% in the OI subgroup. In multivariable analysis, IVF/ICSI was associated with sPPH (OR=1.65, 95%CI 1.02-2.56, p=0.032) and a tendency was observed for donation (OR=4.07, 95%CI 0.83-14.2, p=0.047)(Table1).

    Conclusion(s): IVF/ICSI, the most used technique in ART, is associated with an increased risk for sPPH. Collecting information about conception appears important to evaluate individual risk for PPH and provide appropriate care at delivery.

    Learning Objectives:

    • list and remember some identified risk factors for severe postpartum hemorrhage
    • be aware of the risk of severe postpartum hemorrhage in pregnancies obtained by assisted reproductive techniques
    • explain some mechanisms underlying postpartum hemorrhage, especially in case of assisted reproductive techniques