title: Is there an association between assisted reproductive technologies and time and complications of the third stage of labor?
abstract: To determine if vaginal deliveries exposed to assisted reproductive technologies (ART) are associated with an increased time between delivery of the neonate and placenta and select complications.
  
  
  
  A retrospective cohort of patients enrolled in an infertility practice who had term, singleton, vaginal deliveries at two academic hospitals from 2008 to 2013 was analyzed. Controls were patients with spontaneous conceptions after infertility consultations. The exposure groups were patients with controlled ovarian hyper-stimulation (COH) with in vivo fertilization, COH with in vitro fertilization and fresh embryo transfer (COH/IVF), and frozen embryo transfer or oocyte donation recipients without COH (non-COH ET). Multiple gestations and stillbirths were excluded. Median time of third stage was compared using the Mann-Whitney U test. Secondary outcomes of retained placenta, manual placental extraction, and post-partum hemorrhage (PPH) were compared using Chi-square or Fisher's exact analyses.
  
  
  
  A total of 769 patients met criteria and were analyzed. While there were no differences in time of third stage of labor, retained placenta, or PPH, manual extraction was significantly more common among non-COH ET [age-adjusted OR 5.6 (95 % CI 2.2-13.8); p < 0.001].
  
  
  
  Patients who conceived after non-COH ET were at increased risk for manual placental extraction. This association was not influenced by age differences between groups. Further research must be done to determine which elements of the ART process are responsible for these differences.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, Atlantic Health System, 100 Madison Avenue, Interoffice Box#20, Morristown, NJ, 07960, USA. michael.aziz@atlantichealth.org.
authors.forename: Michael Matean
authors.initials: MM
authors.lastname: Aziz
authors.affiliation: Division of Maternal-Fetal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: George
authors.initials: G
authors.lastname: Guirguis
authors.affiliation: St. George's University School of Medicine, Grenada, WI, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Maratto
authors.affiliation: Division of Maternal-Fetal Medicine, Atlantic Health System, Morristown, NJ, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Benito
authors.affiliation: Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Forman
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007231:Infant, Newborn; D007246:Infertility / Q000628:therapy; D007749:Labor Stage, Third; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010062:Ovulation Induction / Q000009:adverse effects; D018457:Placenta, Retained / Q000453:epidemiology / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Assisted reproductive technology; Complications; Controlled ovarian hyper-stimulation; Manual extraction; Third stage of labor