体外受精-胚胎移植术后双胎之一手术减胎或自然减胎对妊娠结局的影响
Efect of Surgical or Spontaneous Pregnancy Reduction of One Twin after In Vitro Fertilization-Embryo Transfer on Clinical Outcomes
林津 1黄惠 1王桂泉 1张玲 1何雪梅 1邓冰冰 1李萍1
作者信息
- 1. 厦门大学附属妇女儿童医院生殖医学科厦门市生殖与遗传重点实验室,福建厦门 361003
- 折叠
摘要
目的:探讨体外受精-胚胎移植(IVF-ET)治疗中,双胎妊娠实施早期选择性减胎术或胎儿发生自然减胎后对改善妊娠结局的影响.方法:回顾性分析2011年11月至2021年12月在厦门大学附属妇女儿童医院生殖医学科接受常规IVF-ET或卵胞浆内单精子显微注射-胚胎移植(ICSI-ET)的新鲜及冻融胚胎移植获单胎或双胎妊娠的患者共6535个周期(6535例)的临床资料,采用倾向性评分匹配(PSM)方法(1∶4)纳入研究对象,其中,手术减胎组与初始单胎组分别纳入128个周期和510个周期,自然减胎组与初始单胎组分别纳入511个周期和2038个周期.比较各组的妊娠结局指标.结果:PSM后手术减胎组及自然减胎组的移植胚胎数多于初始单胎组,分娩孕周早于初始单胎组,新生儿出生体质量低于初始单胎组,早产率、低出生体质量儿占比高于初始单胎组,差异均有统计学意义(P＜0.05).手术减胎组及自然减胎组的妊娠并发症(产后出血、妊娠期糖尿病、妊娠期高血压疾病)发生率、剖宫产率与初始单胎组比较,差异均无统计学意义(P＞0.05).流产率及新生儿出生缺陷率因PSM模型调整后数据缺失,按调整前计算,手术减胎组及自然减胎组的早期流产率均低于初始单胎组(P＜0.05),自然减胎组晚期流产率低于初始单胎组(P＜0.05);手术减胎组及自然减胎组的活产率高于初始单胎组(P＜0.05);手术减胎组及自然减胎组的新生儿出生缺陷率与初始单胎组比较差异无统计学意义(P＞0.05).结论:辅助生殖技术(ART)助孕所致的多胎妊娠者,即使在孕早期实施减胎手术或发生自然减胎后对孕妇妊娠结局的影响有限,但早产率和低出生体质量儿出生率增加;减胎并不能完全逆转妊娠结局,限制移植胚胎数目才是解决ART助孕妊娠不良结局的根本办法.
Abstract
Objective:To investigate the effect of early selective reduction of twin pregnancies or spontaneous reduction on the improvement of clinical outcome in IVF-ET treatment.Methods:The clinical data of 6535 cycles(6535 cases)of single or twin pregnancy obtained from fresh and frozen-thawed embryo transfer(FET)of IVF or ICSI-ET in the Department of Reproductive Medicine,Women and Children's Hospital Affiliated to Xiamen Univer-sity from November 2011 to December2021 were analyzed retrospectively,The propensity score matching(PSM)method(1∶4)was used to include the study subjects.The surgical reduction group and the spontaneous single-ton group were included in 128 cycles and 510 cycles,respectively.The spontaneous reduction group and the ini-tial singleton group were included in 511 cycles and 2038 cycles,respectively.The pregnancy outcomes of each groups were compared.Results:After PSM,the number of transferred embryos in the surgical and spontaneous reduction group was higher than that in the initial singleton group.The gestational week of delivery was earlier than that of the initial singleton group,and the birth weight of the newborn was lower than that in the initial single-ton group.The rate of premature delivery and low birth weight was higher than that in the initial singleton group,and the difference was statistically significant(P＜0.05).The incidence of pregnancy complications(postpartum hemorrhage,gestational diabetes,hypertensive disorders of pregnancy)and the rate of cesarean section were not significantly different(P＞0.05).The abortion rate and neonatal birth defect rate were missing after adjusting the PSM model.According to the calculation before adjustment,the early abortion rate of the surgical reduction group and the spontaneous reduction group were significantly lower than that in the initial singleton group(P＜0.05),and the late abortion rate of the spontaneous reduction group was lower than that in the initial singleton group,the difference was statistically significant(P＜0.05).There was no significant difference in the neonatal birth defect rate between the surgical/spontaneous reduction group and the initial singleton group(P＞0.05).Conclusions:Patients with multiple pregnancies caused by assisted reproductive technology(ART)may have a relatively poor prognosis in the perinatal period even if the effect of early pregnancy reduction surgery or spontaneous reduction is limited.Reducing the number of embryos transferred cannot completely reverse the pregnancy outcome.Limiting the number of embryos transferred is the fundamental solution to the adverse outcomes of ART assisted pregnancy.
关键词
多胎妊娠减胎术/自然减胎/体外受精-胚胎移植/妊娠结局Key words
Multifetal pregnancy reduction/Spontaneous pregnancy reduction/In vitro fertilization and embryo transfer/Pregnancy outcome引用本文复制引用
基金项目
厦门市医疗卫生指导性项目(3502220209195)
出版年
2023
国家科技期刊平台
NSTL
维普
万方数据