1237例胚胎移植术后母儿的围产结局分析

Analysis of perinatal and neonatal outcomes in 1237 pregnancies through in vitro fertilization

目的回顾性分析西南医院生殖医学中心1 237例胚胎移植术后母儿的围产结局。方法收集整理2011年1月至2014年7月在我中心行体外受精/卵胞浆内单精子显微注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)助孕技术成功妊娠的孕妇1 237例(助孕组),其中鲜胚移植周期711例,冻融胚胎移植周期(frozen thawed embryo transfer,FET)526例,以同期我院收治的自然妊娠孕妇(5 040例)作为对照,分组比较母亲围产期情况及新生儿出生结局。结果助孕组年龄为(30.4±4.2)岁,明显高于对照组(P<0.05);助孕组多胎率及剖宫产率较对照组明显升高(P<0.05);助孕组孕周及新生儿平均体质量较对照组明显偏小(P<0.05);助孕组妊娠期高血压(pregnancy-induced hypertension,PIH)、前置胎盘、妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)、产后出血、母亲入ICU、新生儿住院、低体质量儿、早产以及新生儿入ICU(neonatal ICU,NICU)发生率较对照组明显升高(P<0.05),而胎盘早剥、胎膜早破(premature rupture of fetal membranes,PROM)、先兆子痫、死胎、新生儿死亡及新生儿畸形的发生率两组比较差异无统计学意义。在助孕组内,鲜胚组孕周及新生儿体质量较FET组小(P<0.05),鲜胚组ICP、PROM和产后出血的发生率较FET低,低体质量儿出生率较FET高(P<0.05),而PIH、前置胎盘、先兆子痫、胎盘早剥、母亲入ICU、死胎、新生儿死亡、新生儿住院、新生儿畸形、NICU以及早产的发生率两组间比较差异无统计学意义。结论辅助生殖助孕者的PIH、前置胎盘、ICP、产后出血、母亲入ICU、新生儿住院、低体质量儿、早产以及NICU的发生率较自然妊娠孕妇高。

Objective To retrospectively analyze the perinatal and neonatal outcomes in 1 237 pregnancies through in vitro fertilization （IVF）. Methods A total of 1 237 women who were pregnant in our center through IVF/intracytoplasmic sperm injection （ICSI） assisted pregnancy technologies （APT） from January 2011 to July 2014 were enrolled in this study. They were assigned as APT group, including 711 cases of fresh embryo transfer cycles and 526 cases of frozen thawed embryo transfer cycle （FET）. And another 5 040 cases of natural pregnancy in our hospital during the same period served as the control group. The perinatal and neonatal outcomes were compared among these groups. Results The average age was 30.4±4.2 in the APT group, obviously older than that of the control group （P〈0.05）. The APT group had significantly higher rates of multiple pregnancy and cesarean section than the control group （P〈0.05）, but remarkably shorter average gestational age and lower average body weight of the neonates （P〈0.05）, and obviously higher incidences of pregnancy hypertension （PIH）, placenta previa, pregnancy intrahepatic cholestasis （ICP）, postpartum hemorrhage, mother in ICU, hospitalized neonates, low birth weight infants, preterm delivery and neonatal ICU rate （NICU） （P〈0.05）. There were no significant difference in the incidences of placental abruption, preeclampsia, premature rupture of membranes （PROM）, stillbirth, neonatal death and neonatal malformation between the APT and natural pregnancy groups. In the APT group, the fresh embryo group had significantly shorter gestational age and lower weight of newborn than the FET group （P〈0.05）, but there was no difference in the incidences of PIH, placenta previa, pre eclampsia, placental abruption, mother into ICU, stillbirth, neonatal death, hospitalized neonates, neonatal malformations, NICU and preterm delivery between them （P〉0.05）. Conclusion The incidences of PIH, placenta previa, ICP, postpartum hemorrhage, mother into ICU, hospitalized neonates, low birth weight infants, premature birth and NICU are higher in the APT group than the natural pregnancy group.