辅助生育技术助孕双胎与自然受孕双胎剖宫产分娩的临床对比分析

Clinical analysis of cesarean section delivery on twin pregnancies conceived by assisted reproductive techniques and those conceived spontaneously

目的:探讨辅助生育技术(assisted reproductive technology,ART)助孕双胎与自然受孕双胎剖宫产分娩的围手术期临床情况,为ART助孕双胎围手术期的产科处理提供临床依据。方法:回顾性分析2015年1月至2016年1月我院剖宫产分娩的225例ART助孕双胎和95例自然受孕双胎的围手术期情况。结果:ART助孕组术后血红蛋白水平(HB 108.7±16.3 g/L)下降较自然受孕组(HB 117.4±10.9 g/L)显著,差异有统计学意义(P<0.05)。ART助孕组产后出血比例(4.44%)高于自然受孕组(1.05%),差异有统计学意义(P<0.05)。ART助孕组发生胎盘粘连、胎盘植入比例高于自然受孕组,差异有统计学意义(P<0.05);而两组间前置胎盘发生比例相比,差异无统计学意义(P>0.05)。ART助孕组使用子宫捆绑术、子宫动脉上行支结扎术和促宫缩药物的比例以及输血率均高于自然受孕组,差异有统计学意义(P<0.05)。结论:ART助孕双胎选择剖宫产方式终止妊娠,其产后出血风险更高,围手术期处理更复杂,需加强对其剖宫产分娩的围手术管理。

Objective： The clinical situations of Cesarean section delivery on twin pregnancies conceived by assisted reproductive technology（ART） and those conceived spontaneously were analyzed so as to provide the basis for perioperative care on twin pregnancies conceived by ART. Methods： Perioperative situations were analyzed retrospectively on 225 twin pregnancies conceived by ART（ART group） and 95 spontaneous twin pregnancies（natural pregnancy group） admitted to our hospital from January 2015 to January 2016. Results：There were significant differences in postoperative hemoglobin levels and incidence of postpartum hemorrhage between ART group and natural pregnancy group（P〈0.05）. The incidences of placenta adhesion and placenta increta in ART group were significantly higher than in natural pregnancy group（P〈0.05）. But there was no statistically significant difference in placenta previa between the two groups（P〈0.05）. The B-Lynch suture,ligation of the ascending branch of uterine artery, usage of medications promoting contraction and blood transfusion were performed more frequently in ART group than in natural pregnancy group（P〈0.05）. Conclusion：Cesarean section on twin pregnancies conceived by ART has a higher risk of postpartum hemorrhage and requires a more complicated perioperative treatment regimen. There is a need to strengthen the managements of Cesarean section on twin pregnancies conceived by ART.