辅助生育技术及自然受孕双胎妊娠的围产期情况及新生儿结局:811例回顾性分析

Perinatal complications and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques and those conceived spontaneously: A retrospective analysis of 811 cases

目的探讨辅助生育技术受孕(助孕)双胎妊娠与自然受孕双胎妊娠孕妇的一般情况、妊娠期并发症、分娩情况及新生儿结局等。方法收集2015年1月1日-2016年12月31日在上海交通大学医学院附属国际和平妇幼保健院分娩的811例双胎妊娠孕妇的一般情况、孕期及分娩期资料和新生儿资料等,其中辅助生育技术受孕双胎妊娠孕妇(助孕组)518例,自然受孕双胎妊娠孕妇(自然受孕组)293例。对两组孕妇的基本情况、妊娠期并发症、分娩情况及新生儿结局进行回顾性分析。结果助孕组孕妇年龄大于自然受孕组(P<0.05),但自然受孕组孕妇孕产次多于助孕组(P<0.05);与自然受孕组比较,助孕组双受精卵及双绒毛膜性的比例较高(P<0.05)。助孕组孕妇的妊娠期糖尿病发生率、胎盘异常(胎盘粘连、胎盘植入、前置胎盘)发生率及产后出血量均明显高于自然受孕组(P<0.05),而妊娠期高血压疾病、妊娠期胆汁淤积症等妊娠期并发症发生率两组差异无统计学意义(P>0.05)。两组双胎妊娠孕妇的新生儿出生体重、新生儿窒息率、先天畸形发生率及新生儿死亡发生率差异无统计学意义(P>0.05)。结论助孕双胎妊娠孕妇的妊娠期糖尿病及胎盘异常发生率高,产后出血量多,但其新生儿结局与自然受孕双胎孕妇的新生儿结局无明显差异。

Objective To investigate the general situations of gravida, pregnancy complications, childbirth and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques（ART） and those conceived spontaneously. Methods A retrospective analysis was carried out on the basic information, perinatal complications, delivery information and neonatal outcomes of twin pregnancies received by ART（ART group, n=518） and those conceived spontaneously（SC group, n=293）. Results Gravida age was older in ART group than in SC group（P〈0.05）, while the gravidity and parity in ART group was more than that in SC group（P〈0.05）. There were more embryos and high proportion of diamniotic cyst in ART group than in SC group（P〈0.05）. The gestational incidence of diabetes, abnormal placenta（placental adherence, placenta accrete, placenta previa） and postpartum hemorrhage were higher in ART group than in SC group（P〈0.05）, while no statistically significant differences existed between the two groups in the incidence of gestational complications（such as gestational hypertension disease, cholestasis and amniotic fluid volume abnormality） and in neonatal outcomes including neonatal weight, incidence of asphyxia and congenital malformation and neonatal death（P〉0.05）. Conclusion Twin pregnancy conceived by ART may lead to higher incidences of gestational diabetes mellitus and abnormal placenta and more postpartum hemorrhage, but no significant difference existed in the neonatal outcomes between twin pregnancies conceived by ART and those conceived spontaneously.