Placenta previa in in vitro fertilization and unassisted pregnancies–is there a difference in perinatal outcomes and placental histology?

Figures & data

Table 1. Demographic characteristics of IVF and control groups.

	IVF group n = 23	Control group n = 159	p
Age, (years), mean ± SD	34.4 ± 4.8	32.6 ± 4.8	.10
BMI (kg/m^2), mean ± SD	24.6 ± 4.9	23.6 ± 4.3	.37
Gravidity, median (range)	2 (1-6)	3 (1-12)	.007
Parity, median (range)	0 (0-2)	2 (0-7)	<.001
Nulliparous, n (%)	11 (47.8)	27 (17.0)	<.001
Previous CD, n (%)	5 (21.7)	62 (38.9)	.10
Previous previa, n (%)	1 (4.3)	5 (3.1)	.56
DM, n (%)	5 (21.7)	13 (8.1)	.04
Smokers, n (%)	3 (13.0)	35/158(22.1)	.41
Thrombophilia, n (%)	1 (4.3)	5 (3.1)	.56

IVF: in vitro fertilization; BMI: body mass index, pre-gestational; CD: cesarean delivery; DM: diabetes mellitus, pre-gestational or gestational.

Table 2. Obstetric and neonatal outcome in the IVF and control groups.

	IVF group n = 23	Control group n = 159	p
Bleeding during pregnancy, n (%)	14 (60.8)	90 (56.6)	.69
Betamethasone treatment during pregnancy, n (%)	6 (26.0)	58 (36.4)	.32
Preeclampsia, n (%)	2 (8.7)	2 (1.2)	.07
Gestational age, (weeks), mean ± SD	36.0 ± 2.8	35.9 ± 2.8	.81
Premature delivery, n (%)	11 (47.8)	76 (47.8)	>.99
Placenta accrete, n (%)	0	14 (8.8)	.22
Maternal blood transfusion, n (%)	3 (13.0)	47 (29.5)	.13
Maternal hemoglobin post CD, (g/dL), mean ± SD	9.7 ± 1.2	9.2 ± 1.5	.10
Birth weight, (grams), means ± SD	2731 ± 662	2607 ± 624	.37
Small for gestational age, n (%)	2 (8.7)	19 (11.9)	>.99
Five-minute Apgar score <7, n (%)	1 (4.3)	5/158 (3.1)	.56
Cord pH <7.1, n (%)	0/20	3/147 (2.0)	>.99
Adverse composite neonatal index, n (%)	9 (39.1)	61 (38.3)	.94

IVF: in vitro fertilization, premature delivery–under 37 weeks, adverse composite neonatal index was defined as at least one of the following: phototherapy, respiratory distress, sepsis, blood transfusion, cerebral complications, necrotizing enterocolitis (NEC), neonatal intensive care unit (NICU) admission or neonatal death.

Table 3. Placental findings in the IVF and control groups.

	IVF group n = 23	Control group n = 159	p
Placental weight, (grams), mean ± SD	496 ± 135	450 ± 118	.09
Placental weight <10th percentile, n (%)	3 (13.0)	76 (47.8)	.001
Macroscopic abruption, n (%)	2 (8.7)	12/157 (7.6)	.69
Maternal vascular malperfusion (MVM) lesions
Composite MVM lesions, n (%)	6 (26.0)	57 (35.8)	.35
Marginal/retroplacental hematoma, n (%)	0	13 (8.1)	.37
Vascular lesions	2 (8.7)	11 (6.9)	.67
Villous changes	5 (21.7)	41 (25.7)	.67
Fetal vascular malperfusion (FVM) lesions
Composite FVM lesions, n (%)	2 (8.7)	27 (16.9)	.54
Vascular lesions	1 (4.3)	19 (11.9)	.47
Villous changes	1 (4.3)	11 (6.9)	>.99
Inflammatory lesions
VUE, n (%)	1 (4.3)	7 (4.4)	>.99
Chorioamnionitis, n (%)	0	1 (0.6)	>.99

IVF: in vitro fertilization; VUE: villitis of unknown etiology, chorioamnionitis–maternal and/or fetal inflammatory responses.

Maternal vascular malperfusion lesions – marginal and retro-placental hematoma; vascular changes–acute atherosis and mural hypertrophy; villous changes–increased syncytial knots, villous agglutination, increased intervillous fibrin deposition, distal villous hypoplasia, and parenchymal infarcts.

Fetal vascular malperfusion lesions – Vascular lesions–thrombosis of the chorionic plate and stem villous vessels; villous changes–villous stromal-vascular karyorrhexis and avascular villi.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [EB], upon reasonable request.