不同黄体支持方案对新鲜周期移植双胎妊娠围生期结局的比较

Perinatal Outcome of Fresh Cycle Embryo Transplantation of Twin Pregnancy with Different Luteal Support Methods

目的:比较阴道用黄体酮缓释凝胶和注射用黄体酮针两种黄体支持方案对卵裂期新鲜胚胎移植周期双胎妊娠围生期结局的影响。方法:回顾性分析2011年1月至2016年3月在郑州大学第三附属医院生殖医学中心行体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)孕早期临床确诊双胎妊娠患者900例(共900个周期),采用电话随访和电子病历查询方法,其中双胎分娩患者共705个周期,依据移植时黄体支持方案分为注射用黄体酮针组(551个周期)和阴道用黄体酮缓释凝胶组(154个周期)。比较两组间围生期妊娠期并发症发生率及妊娠结局、新生儿结局的差异。结果:两组间流产(早期流产、晚期流产)、死胎、死产、自然减胎、行减胎术、活产率(活单胎、活双胎率)比较,差异均无统计学意义(P>0.05)。阴道用黄体酮缓释凝胶组的妊娠期糖尿病发生率(8.4%)较注射用黄体酮针组(3.8%)高,差异有统计学意义(P<0.05),余妊娠期并发症两组间差异无统计学意义(P>0.05)。两组间新生儿畸形、出生后死亡、平均出生体质量差异无统计学意义(P>0.05)。结论:阴道用黄体酮缓释凝胶黄体支持方案使用方便,患者依从性好,且可获得与注射用黄体酮针相似的双胎妊娠围生期结局。

Objective：To evaluate the perinatal outcome of progesterone sustained-released vaginal gel（Crinone^（c） 8% ）and intramuscular progesterone in oil（ IMP）for luteal phase support in twin pregnancy with fresh em- bryo transfer. Methods：A retrospective analysis of women experienced IVF/ICSI-ET and were early diagnosed as twin pregnancy in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University be- tween January 2011 and March 2016, a total of 900 cycles, was conducted. By using telephone follow-up and electronic medical records query method,a total of 705 women reached the criteria and were divided into proges- terone injection group（551 cycles）and progesterone vagina slow-release gel group（ 154 cycles）. The incidence of pregnancy complications,outcome of pregnancy and neonatal outcome of the two groups were compared. Re- suits：There was no significant difference between the two groups in the abortion rate,early abortion rate,late a- bortion rate,still birth rate,dead-birth rate, natural birth reduction rate, line reduction surgery rate, live birth rate, live single and twins rates（ P 〉 0.05）. Significant difference was found in the rate of gestational diabetes between Crinone 8% group （8.4%） and IMP group （3.8%） （ P 〈 0.05）, No significant difference was found in pregnancy complications, neonatal malformations and mean birth weight （P 〉 0. 05 ）. Conclusions： Vaginal progesterone sustained release gel is more convenient to use and can obtain similar perinatal outcome in comparison with the injection of progesterone.