试管婴儿围生期并发症的临床分析

发布时间：2018-03-31 22:06

本文选题：体外受精　切入点：胚胎移植　出处：《河北医科大学》2014年硕士论文

【摘要】：目的：探讨经过体外受精-胚胎移植技术(IVF-ET)受孕后出生的试管婴儿与自然受孕出生的新生儿的宫内生长发育情况、新生儿合并症及母亲围产期的并发症，进而以评价人类辅助生殖技术(Assisted ReproductiveTechnology，ART)的安全性及可行性,为试管婴儿的临床救治提供指导。方法：研究对象为2011年1月至2013年12月期间，在河北医科大学第二医院接受IVF-ET的178例母亲所生的活产婴儿264例(试管婴儿组)，包括单胎92例，双胎85例，三胎1例,其中死婴1例；及随机抽取的同期分娩自然受孕的241例母亲所生的活产婴儿256例(自然受孕组)：其中单胎226例，双胎15例。通过对试管婴儿组及自然受孕组的临床分析，比较两组的母亲年龄、是否多胎、剖宫产率、早产率、妊娠期合并症及胎儿的宫内窘迫、同时还比较两组新生儿的生后窒息、先天缺陷、生长发育情况及生后合并症。结果用SPSS13.0软件包进行统计学处理，两组的计量资料应用t检验，计数资料采用卡方检验方法，数据服从正态性分布的用均数±标准差(x±s)表示，P0.05为差异有统计学意义。结果： 1在多胎妊娠与早产方面试管婴儿组与自然受孕组的比较：试管婴儿组多胎妊娠率为48.3%(86/178)，自然受孕组的多胎妊娠率是6.2%(15/241)，差异有统计学意义(X2为99.145，P0.05)；试管婴儿组的早产发生率为40.4%(72/178)，自然受孕组早产率为19.5%(47/241)，两组差异有统计学意义(X2为22.092，P0.05)。 2母亲年龄及剖宫产方面试管婴儿组与自然受孕组的比较：试管婴儿组母亲平均年龄为33.53±4.69岁，自然受孕组母亲平均年龄为27.76±3.93岁，两组差异有统计学意义(t为13.337，P0.05)；试管婴儿组剖宫产率为81.5%(145/178)，自然受孕组剖宫产率为51.0%(123/241),两组差异有统计学意义(X2为41.111，P0.05)。 3妊娠期糖尿病和妊娠期高血压(简称妊高症)方面试管婴儿组与自然受孕组的比较：试管婴儿组母亲患妊娠期糖尿病的有9.0%(16/178)，，自然受孕组有4.1%(10/241),两组差异有统计学意义(X2为4.120，P0.05)；试管婴儿组母亲妊高症发生率为25.8%(46/178)，自然受孕组发生率为14.5%(35/241),两组差异有统计学意义(X2为8.413，P0.05)。 4试管婴儿组胎盘异常的有4.5%(8/178)，脐带异常的有18.0%(32/178)，胎膜早破的有14.0%(25/178)，自然受孕组胎盘异常为5.4%(13/241)、脐带异常为21.2%(51/241)、胎膜早破的有8.7%(21/241),两组在胎盘、脐带异常及胎膜早破上差异均无统计学意义(P0.05)。 5试管婴儿组与自然受孕组在宫内窘迫及生后窒息方面的比较：试管婴儿组宫内窘迫的发生率是6.7%(12/178)，自然受孕组是3.3%(8/241)；试管婴儿组生后窒息的有10.6%(28/264)，自然受孕组有7.8%(20/256),两组在宫内窘迫及生后窒息上差异均无统计学意义(P0.05)。 6试管婴儿组新生儿生后转儿科的有43.2%(114/264)，自然受孕组有31.6%(81/256)，差异有统计学意义(X2为7.386，P0.05)。 7在宫内生长发育方面，试管婴儿组小于胎龄儿占8.3%(22/264),适于胎龄儿占85.6%(226/264),大于胎龄儿占6.1%(16/264),自然受孕组分别占7.8%(20/256)，83.2%(213/256)，9.0%(23/256),两组在宫内生长发育上差异无统计学意义(X2为1.614，P0.05)。 8试管婴儿组新生儿呼吸窘迫综合征(NRDS)、新生儿高胆红素血症的患病率均显著高于自然受孕组,分别为9.8%(26/264)和4.7%(12/256)，22.3%(59/264)和14.1%(36/256),差异上均有统计学意义(X2分别为5.111和5.976，P0.05)。试管婴儿组先天畸形发生率为9.8(26/264)，自然受孕组为5.1%(13/256)，两者差异上有统计学意义(X2为4.263，P0.05)。 9试管婴儿组肺出血、呼吸暂停、低血糖的发生率依次为3.8%(10/264)、12.5%(33/264)、13.6%(36/264)，自然受孕组分别为3.1%(8/256)、9.4%(24/256)、9.8%(25/256)，前者均高于后者，但是差异无统计学意义(P0.05)；在肺炎、电解质异常（低钠血症、低钙血症、低钾血症）方面自然受孕组发生率稍高于试管婴儿组，分别为19.5%(50/256)和17.0%(45/264)、13.7%(35/256)和11.4%(30/264)，差异并无统计学意义(P0.05)。结论： 1试管婴儿的多胎率、剖宫产率、早产率明显高于自然受孕组。 2试管婴儿母亲妊高症和糖尿病发生率及年龄均显著高于自然受孕组、这些因素会不同程度的影响新生儿的生存质量。 3由于试管婴儿的特殊性，一些新生儿的并发症也随之出现，本研究显示，试管婴儿组新生儿RDS、新生儿高胆红素血症、先天畸形发生率显著高于自然受孕组，但在肺炎、肺出血、呼吸暂停、血糖及电解质异常方面无明显差别。 4试管婴儿组在宫内生长发育上与自然受孕组无差别。 5减少试管婴儿的多胎妊娠，密切监测多胎妊娠的围产期并发症，降低早产是提高试管婴儿新生儿存活率和生存质量的关键。
[Abstract]:Objective : To evaluate the safety and feasibility of assisted reproduction technology ( ART ) and provide guidance for the clinical treatment of infants born after IVF - ET .

Methods : 264 cases of live births attended by 178 mothers of IVF - ET in the Second Hospital of Hebei Medical University between January 2011 and December 2013 were studied .
A total of 256 live births attended by two groups of mothers were compared between the two groups . The results were analyzed by SPSS 13.0 software . The results showed that there were no statistical differences between the two groups .

Results :

The pregnancy rate was 48.3 % ( 86 / 178 ) in the test tube group and 6.2 % ( 15 / 241 ) in the natural pregnancy group ( X2 = 99.145 , P0.05 ) .
The preterm birth rate of the test tube group was 40.4 % ( 72 / 178 ) , and the preterm birth rate was 19.5 % ( 47 / 241 ) . There was significant difference between the two groups ( X2 = 22.092 , P0.05 ) .

The average age of mother ' s mother was 33.53 卤 4.69 years old , the average age of mother was 27.76 卤 3.93 years , there was significant difference between the two groups ( t = 13.337 , P0.05 ) .
The cesarean section rate was 81.5 % ( 145 / 178 ) in the test tube group and 51.0 % ( 123 / 241 ) in the natural pregnancy group . There was significant difference between the two groups ( X2 = 41.111 , P0.05 ) .

In pregnant women with gestational diabetes mellitus and pregnancy induced hypertension ( PIH ) , the incidence of gestational diabetes was 9.0 % ( 16 / 178 ) and 4.1 % ( 10 / 241 ) in the natural pregnancy group ( X2 = 4.120 , P0.05 ) .
The incidence of pregnancy - induced hypertension in test tube group was 25 . 8 % ( 46 / 178 ) and 14.5 % ( 35 / 241 ) in the natural pregnancy group , and the difference was statistically significant ( X2 = 8.413 , P0.05 ) .

4 . 5 % ( 8 / 178 ) of the placental abnormality in the test tube infants , 18.0 % ( 32 / 178 ) of the umbilical cord abnormality , 14.0 % ( 25 / 178 ) of the premature rupture of the membranes , and 8.7 % ( 21 / 241 ) of the premature rupture of the membranes . There was no statistical difference between the two groups in the placenta , umbilical cord and fetal membranes ( P0.05 ) .

The incidence of intrauterine distress was 6.7 % ( 12 / 178 ) and 3.3 % ( 8 / 241 ) .
There were 10 . 6 % ( 28 / 264 ) asphyxia in the test tube group and 7.8 % ( 20 / 256 ) in the natural pregnancy group . There was no significant difference between the two groups ( P0.05 ) .

There were 43.2 % ( 114 / 264 ) in the infant group after birth and 31.6 % ( 81 / 256 ) in the natural pregnancy group ( X2 = 7.386 , P0.05 ) .

7 . In the aspect of intrauterine growth , the test tube group was less than the gestational age ( 8.3 % ) ( 22 / 264 ) , which was suitable for gestational age ( 85.6 % ) ( 226 / 264 ) , which was more than 6.1 % ( 16 / 264 ) of gestational age , and the natural pregnancy group accounted for 7.8 % ( 20 / 256 ) , 83.2 % ( 213 / 256 ) and 9.0 % ( 23 / 256 ) respectively . There was no significant difference in the growth and development of the two groups ( X2 = 1.614 , P0.05 ) .

The prevalence rates of neonatal respiratory distress syndrome ( NRDS ) and neonatal hyperbilirubinaemia were significantly higher than those in the natural pregnancy group ( 9 . 8 % ( 26 / 264 ) and 4.7 % ( 12 / 256 ) , 22.3 % ( 59 / 264 ) and 14.1 % ( 36 / 256 ) , respectively . The incidence of congenital malformations in the test tube group was 9.8 ( 26 / 264 ) and 5.1 % ( 13 / 256 ) , respectively . There was a significant difference between the two groups ( X2 = 4.263 , P0.05 ) .

9 . The incidence of pulmonary hemorrhage , apnea , hypoglycemia was 3.8 % ( 10 / 264 ) , 12.5 % ( 33 / 264 ) , 13.6 % ( 36 / 264 ) in the test tube group , and 3.1 % ( 8 / 256 ) , 9.4 % ( 24 / 256 ) and 9.8 % ( 25 / 256 ) respectively .
The incidence of natural pregnancy group was slightly higher in pneumonia , electrolyte abnormality ( hypsomia , hypocalcemia , hypokalaemia ) than that in the test group , respectively 19.5 % ( 50 / 256 ) and 17.0 % ( 45 / 264 ) , 13.7 % ( 35 / 256 ) and 11.4 % ( 30 / 264 ) , respectively , and there was no statistical significance ( P0.05 ) .

Conclusion :

The fetal rate , cesarean section rate and preterm birth rate of the test tube infants were significantly higher than those of the natural pregnancy group .

The incidence and age of pregnancy - induced hypertension and diabetes in test - tube infants were significantly higher than those in the natural pregnancy group . These factors influence the quality of life of the newborn .

3 Due to the particularity of the test tube infants , the complications of some newborns also appeared . This study shows that the incidence of RDS , neonatal hyperbilirubinaemia and congenital malformations in the test tube infants group is significantly higher than that of the natural pregnancy group , but there is no significant difference in pneumonia , pulmonary hemorrhage , apnea , blood sugar and electrolyte abnormalities .

There was no difference in the growth and development of the test tube baby group compared with that of the natural pregnancy group .

5 Reduction of fetal pregnancy in test tube infants , closely monitoring the perinatal complications of multiple pregnancy , reducing preterm birth is the key to improve the survival rate and quality of life of newborn infants .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

【引证文献】