MANUSCRIPT
Dear Editor,
I read with great interest the study evaluating the potential impact of
Frozen-IVF on serious maternal outcomes such as postpartum hemorrhage
(PPH) and reporting an increased risk of major PPH associated with
frozen embryo transfers in this patient group, based on data from a
significant number of patients. However, I would like to express two
concerns regarding the article.
ACOG (2017) defines postpartum hemorrhage (PPH) as the cumulative loss
of 1000 mL or more blood within the first 24 hours after birth or
bleeding accompanied by signs or symptoms of hypovolemia [1]. On the
other hand, RCOG (2016) categorizes PPH into minor (blood loss 500-1000
cc) and major (blood loss greater than 1000 ml) [2].
The authors, however, have noted the unreliability of the definition of
PPH based on the amount of blood loss. They have included patients in
the regression analysis as PPH who received at least one unit of blood
transfusion or those with records in computer-based hospital records
indicating hysterectomy, uterine, or hypogastric artery ligation.
Both RCOG and ACOG have indicated that there is no definite criterion to
initiate red blood cell transfusion in PPH and that the decision to
provide blood transfusion should be based on both clinical and
hematologic assessment. We fully agree with these guidelines. This is
because in a pregnant woman with a high pre-delivery hemoglobin level,
PPH may not always necessitate blood transfusion. Conversely, in a
pregnant woman with a low hemoglobin level, even minimal postpartum
bleeding can lead to symptomatic conditions, requiring blood transfusion
for the patient.
Additionally, 34 patients in the fresh-IVF group and 29 patients in the
frozen-IVF group were included in the analysis as PPH cases. Although
the study had a substantial number of natural conception cases, the
multitude of confounding factors influencing PPH limited the statistical
reliability in the conducted multivariate analysis. Despite adjusting
for placental pathologies in the regression, a more detailed examination
of the placental pathology status in IVF patients experiencing PPH could
have been beneficial.