妊娠合并中重度卵巢过度刺激综合征患者的临床结局分析

Clinical outcome analysis of pregnant women with moderate to severe ovarian hyperstimulation syndrome

目的 探讨辅助生殖助孕后妊娠合并中、重度卵巢过度刺激综合征(OHSS)患者的临床结局。 方法 回顾性分析2014年6月至2017年12月在我院行IVF/ICSI-ET治疗并妊娠的1182个周期的病例资料。按照是否合并OHSS分为2组:妊娠合并OHSS组(n=93)和对照组(n=1089)。根据妊娠早期孕囊数目进一步将妊娠合并OHSS组分为OHSS单胎组(n=43)和OHSS双胎组(n=50);对照组分为正常单胎组(n=738)和正常双胎组(n=351)。按照OHSS的严重程度以及妊娠早期孕囊数将93个妊娠合并OHSS周期分为中度OHSS单胎组(n=29),中度OHSS双胎组(n=37),重度OHSS单胎组(n=14)和重度OHSS双胎组(n=13)。 结果 妊娠合并OHSS组基础窦卵泡计数、获卵数、HCG日E2水平均显著高于对照组(P均<0.01)。妊娠合并OHSS组双胎妊娠率显著高于对照组(53.8%vs.32.2%,P<0.05);OHSS单胎组与对照单胎组,OHSS双胎组与对照双胎组的周期分娩率、异位妊娠率、流产率、剖宫产率、早产率、产科并发症发生率、低出生体重儿率、分娩孕周、新生儿出生体重均无显著性差异(P>0.05);妊娠合并OHSS组及对照组行组内比较,单胎妊娠患者的分娩孕周、新生儿出生体重均显著高于双胎妊娠患者(P<0.05),单胎妊娠患者早产率显著低于双胎妊娠患者(P<0.05)。中度OHSS组与重度OHSS组间比较,双胎妊娠率、周期分娩率、异位妊娠率、流产率、剖宫产率、早产率、产科并发症发生率、分娩孕周、新生儿出生体重均无显著性差异(P均>0.05);中度OHSS组与重度OHSS组的双胎妊娠新生儿出生体重均显著低于同组单胎妊娠(P均<0.05),中度OHSS组内双胎妊娠分娩孕周显著低于单胎妊娠(P<0.05)。 结论 妊娠合并中、重度OHSS并未增加不良妊娠结局的发生率。

Objective : To investigate the clinical outcomes of pregnant women complicated with moderate and severe ovarian hyperstimulation syndrome(OHSS)in assisted reproductive technology. Methods : The data of 1 182 patients undergoing IVF-ET treatment in our hospital from June 2014 to December 2017 were retrospectively analyzed.According to whether OHSS is complicated or not,the patients were divided to two groups:pregnancy with OHSS group( n =93)and control group( n =1 089).According to the number of gestational sacs in early pregnancy,the pregnancy with OHSS group was further divided into OHSS singleton group( n =43)and OHSS twin group( n =50).Similarly,the control group was divided into normal singleton group( n =738)and normal twin group( n =351).According to the severity of OHSS and the number of gestational sacs in early pregnancy,93 gestational cycles complicated with OHSS were divided into 4 groups,moderate OHSS singleton group( n =29),moderate OHSS twin group( n =37),severe OHSS singleton group( n =14)and severe OHSS twin group( n =13). Results : The antral follicle count,the numbers of oocytes retrieved and the level of E 2 on the HCG day in pregnancy with OHSS group were significantly higher than those in control group( P <0.01).The twin pregnancy rate in pregnancy with OHSS group was significantly higher than that in the control group(53.8% vs.32.2%)( P <0.05).There were no significant differences in the rates of cyclic delivery,ectopic pregnancy,abortion,cesarean section,preterm birth,obstetric complication and low birth weight,as well as neonatal birth weight & gestational age between OHSS singleton group and normal singleton group,OHSS twin group and normal twin group( P >0.05).In the internal comparison in pregnancy with OHSS group and control group,the average gestational age and neonatal birth weight of singleton group were significantly higher than those of twins group( P <0.05),and the preterm birth rate in singleton group was significantly lower than that in the twins group( P <0.05).There were no significant differences in the rates of twin pregnancy,cyclic delivery,ectopic pregnancy,abortion,cesarean section,preterm and obstetric complication,as well as neonatal birth weight & gestational age between the moderate OHSS group and the severe OHSS group(all P >0.05).The neonatal birth weight of twin pregnancy was significantly lower than that of singleton pregnancy in the moderate OHSS group and the severe OHSS group( P <0.05).The gestational age of twin pregnancy was significantly lower than singleton pregnancy in moderate OHSS group( P <0.05). Conclusions : Pregnant women complicated with moderate and severe OHSS does not increase the incidence of adverse pregnancy outcomes.