Pregnancy outcomes of fetal reduction in patients with intrauterine haematoma following double embryo transfer

Abstract

Research questionIs there an association between intrauterine hematoma(IUH) and pregnancy outcomes in patients receiving fetal reduction(FR) after double embryo transfer? What is the relationship between IUH-related characteristics and pregnancy outcomes? DesignClinical information and pregnancy outcomes of women receiving FR after double embryo transfer were analyzed. Patients with other systematic diseases, ectopic pregnancy or heterotopic pregnancy, monochorionic twin pregnancies and incomplete data were excluded. Stratification of IUH pregnancies was done according to IUH-related characteristics. The main outcome measures included incidence of fetal demise(<24 weeks) while other adverse pregnancy outcomes were considered as secondary outcomes. Result(s)34 IUH patients and 136 non-IUH patients receiving FR after double embryo transfer(DET) were included based on 1:4 match for age, cycle type and fertilization method. IUH patients had higher incidence of early fetal demise(20.6% vs. 7.4%, p=0.048), threatened abortion(48.1% vs. 10.3%, p<0.001) and postpartum hemorrhage(14.8% vs. 4.0%, p=0.030)after FR compared with non-IUH patients, whereas IUH was an independent risk factor for early fetal demise(OR 3.34 95%CI 1.14-9.77) and threatened abortion(OR 8.61, 95%CI: 3.28-22.61) after adjusting for potential confounders. IUH pregnancies undergoing FR resulted in miscarriage had larger IUH volumes and earlier diagnosis. However, IUH characteristics(i.e. volume, changing pattern, presence or absence of cardiac activities) were not correlated with fetal demise and threatened abortion. Conclusion(s)Fetal reduction should be performed with caution in IUH pregnancies after double embryo transfer since the risks of fetal demise is relatively high. Special attention should be given to IUH patients after FR noticing the early signs of threatened abortion and inevitable fetal demise.