体外受精-胚胎移植术后双绒毛膜双胎之一自然减胎临床结局研究

Clinical outcome of spontaneous pregnancy reduction of dichorionic twins after in vitro fertilization and embryo transfer

目的探讨体外受精-胚胎移植术后双绒毛膜双胎(DCDA)之一自然减胎的发生率及其对妊娠结局的影响。方法回顾性分析2009年1月至2015年12月在中山大学附属第一医院行体外受精-胚胎移植的DCDA妊娠病例共4162例,其中双胎自然减灭一胎组745例;未发生自然减胎的3661例作为双胎对照组;同期单胎妊娠的14521个周期作为单胎对照组。首先描述双胎之一自然减胎的总体发生率以及其在不同孕周的发生率;然后比较其与双胎对照组、单胎对照组的临床妊娠结局;最后通过回归模型明确双胎之一自然减胎是否降低抱婴回家可能性的高危因素。结果双胎之一自然减胎的总体发生率为17.9%,其中绝大部分发生在早孕期。自然减胎组在流产率、早产率、活产率、抱婴回家率、分娩孕周及新生儿出生体重等各方面的结局指标均显著优于未发生自然减胎的双胎对照组;活产率、抱婴回家率和新生儿出生体重等主要结局与单胎对照组无明显差异。多因素回归分析结果显示,当未发生自然减胎时,抱婴回家的可能性显著下降(OR=0.73,P=0.008);自然减胎不是降低抱婴回家可能性的高危因素。结论自然减胎是体外受精-胚胎移植术后DCDA的常见现象。自然减胎对存活胎儿的影响不大,其临床结局良好,不降低抱婴回家的可能性。

Objective To investigate the incidence of spontaneous pregnancy reduction of dichorionic twins after in vitro fertilization and embryo transfer（IVF-ET）and its effect on pregnancy outcome. Methods A retrospective analysis of 4162 cases of dichorionic twin pregnancy after IVF-ET during 2009-2015 was conducted. Spontaneous pregnancy reduction happened in 745 cases.Totally 3661 cases of twin pregnancy without spontaneous fetal reduction were analyzed as twin control group;14521 cases with single pregnancy during the same period were analyzed as singleton control group. We described the overall incidence of spontaneous pregnancy reduction,and compare the clinical outcomes with twin control group and singleton control group;finally,through the regression model,we analyzed whether spontaneous fetal reduction was an independent risk factor of adverse pregnancy outcome.Results The overall incidence of spontaneous abortion was 17.9%,most of which occurred during early pregnancy. The miscarriage rate,premature delivery rate,live birth rate,take-home baby rate,gestational age and birth weight in fetal reduction group were significantly better than those of twin control group. The take-home baby rate,live birth rate and neonatal birth weight were not inferior to those of singleton control group. Result of regression analyses showed that twin pregnancy without spontaneous fetal reduction significantly decreased the possibility of taking baby home（OR = 0.73,P=0.008）. Spontaneous fetal reduction was not an independent risk factor of adverse pregnancy outcome.Conclusion Spontaneous pregnancy reduction is common in chorionic twin pregnancy after IVF-ET,which does not adversely affect the pregnancy outcome.