体外受精-胚胎移植术后双绒毛膜双胎之一自然减胎临床结局研究

发布时间：2019-01-24 19:11

【摘要】：目的探讨体外受精-胚胎移植术后双绒毛膜双胎(DCDA)之一自然减胎的发生率及其对妊娠结局的影响。方法回顾性分析2009年1月至2015年12月在中山大学附属第一医院行体外受精-胚胎移植的DCDA妊娠病例共4162例,其中双胎自然减灭一胎组745例;未发生自然减胎的3661例作为双胎对照组;同期单胎妊娠的14521个周期作为单胎对照组。首先描述双胎之一自然减胎的总体发生率以及其在不同孕周的发生率;然后比较其与双胎对照组、单胎对照组的临床妊娠结局;最后通过回归模型明确双胎之一自然减胎是否降低抱婴回家可能性的高危因素。结果双胎之一自然减胎的总体发生率为17.9%,其中绝大部分发生在早孕期。自然减胎组在流产率、早产率、活产率、抱婴回家率、分娩孕周及新生儿出生体重等各方面的结局指标均显著优于未发生自然减胎的双胎对照组;活产率、抱婴回家率和新生儿出生体重等主要结局与单胎对照组无明显差异。多因素回归分析结果显示,当未发生自然减胎时,抱婴回家的可能性显著下降(OR=0.73,P=0.008);自然减胎不是降低抱婴回家可能性的高危因素。结论自然减胎是体外受精-胚胎移植术后DCDA的常见现象。自然减胎对存活胎儿的影响不大,其临床结局良好,不降低抱婴回家的可能性。
[Abstract]:Objective to investigate the incidence of spontaneous reduction of (DCDA) in twin chorionic twins after in vitro fertilization and embryo transfer (IVF) and its influence on pregnancy outcome. Methods from January 2009 to December 2015, 4162 cases of DCDA pregnancy underwent IVF and embryo transfer in the first affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. 3661 cases of spontaneous fetal reduction were used as twin control group, while 14 521 cycles of single pregnancy were used as single pregnancy control group. The total incidence of one of the twins and their incidence in different gestational weeks were described, and then the clinical pregnancy outcome was compared with that in the twin control group and the single pregnancy control group. Finally, the regression model is used to determine whether the natural reduction of twin pregnancy is a high risk factor for reducing the possibility of infantile delivery home. Results the overall incidence of one of the twins was 17.9, most of which occurred in the early pregnancy. The rate of abortion, premature delivery, live delivery, home delivery rate, gestational weeks of delivery and birth weight of newborns in the natural reduced fetus group were significantly better than those in the control group. There was no significant difference in the main outcomes of live birth rate, home delivery rate and birth weight between single child control group and single child control group. The results of multivariate regression analysis showed that the probability of home delivery decreased significantly (OR=0.73,P=0.008) when there was no spontaneous reduction of fetus, and that natural reduction was not a high risk factor to reduce the possibility of home delivery. Conclusion Natural fetal reduction is a common phenomenon of DCDA after in vitro fertilization and embryo transfer. Natural fetal reduction has little effect on surviving fetus, and its clinical outcome is good, and it does not reduce the possibility of infantile home.
【作者单位】：中山大学附属第一医院生殖医学中心;
【基金】：广东省生殖医学重点实验室专项(2012A061400003) 中华医学会临床医学科研专项资金-生殖医学青年医师研究与发展项目(16020410657)
【分类号】：R714.8

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