体外受精-胚胎移植术后双胎妊娠之一发育停止后存留胎儿的妊娠结局

Analysis of pregnancy outcomes of the remaining fetus in twin pregnancies with the co-twin death after IVF-ET

目的探讨体外受精～胚胎移植术（IVF-ET）后宫内双胎妊娠之一发育停止后存留胎儿的妊娠结局。方法对2004年1月—之012年6月在本科室行IVF-ET、单精子卵胞浆内注射术（ICSI）后获得妊娠的临床资料进行回顾性分析，比较IVF-ET、ICSI术后双胎妊娠存留胎儿（另一胎儿在孕早期，≤12周或孕中晚期，〉12周发育停止）与同期IVF-ET术后单胎妊娠的妊娠结局。结果宫内双胎妊娠之一〉12周发育停止组分娩孕周和新生儿出生体重[（36．3±1．8）周、（2656．3±664．6）g]，双胎妊娠组分娩孕周、新生儿体重、早产和低体重儿发生率[（35．1±2．4）周、（2515．8±493．6）g、50．9％、28．2％]，双胎妊娠之一〉12周发育停止组早产、低体重儿发生率和新生儿死亡率（30．9％、21．8％、3．6％），与单胎妊娠组比较，差异有统计学意义。结论IVF-ET后双胎妊娠之一在孕中晚期（〉12周）发育停止后存留胎儿的妊娠结局较单胎妊娠差。

Objective The purpose of this study was to discuss the pregnancy outcomes of the remaining fetus in intrauterine twin pregnancies with the co-twin death after in vitro fertilization and embryo transfer （IVF-ET）. Methods Retrospective analysis was conducted on the clinical data obtained from IVF-ET and intracytoplasmic sperm injection （ICSI） performed in our department from Jan 2004 to June 2012. We compared the pregnancy outcomes of the remaining fetus in twin pregnancies （the co-twin death occurring either ≤ 12 gestational weeks or 〉 12 gestational weeks） with that of single pregnancies from IVF-ET. Results Statistically significant differences were observed when we compared the outcomes of single pregnancies with that of twin pregnancies and cases of co-twin death occurring 〉 12 weeks, including gestational weeks and birth weight [ （36. 3 ±1.8） week, （2 656.3 ±664. 6） g] in cases with co-twin death occurring 〉 12 weeks; gestational weeks, birth weight, premature birth, and the occurrence of low-birth-weight baby [ （35.1 ±2.4） week, （2 515.8 ±493.6） g, 50.9%, 28.2% ] in twin pregnancies; premature birth, the occurrence of low- birth-weight baby, and neonatal death rate （ 30. 9%, 21.8%, 3.6% ） in cases with co-twin death occurring 〉 12 weeks. Conclusion After IVF-ET, the remaining fetus in twin pregnancies where the co-twin death occurred after 12 gestational weeks had worse pregnancy outcomes than that of single presnancies.