体外受精-胚胎移植术后单胎妊娠早产相关因素的临床研究

Clinical study on related factors of premature birth of single pregnancy after in vitro fertilization and embryo transfer

目的探讨体外受精-胚胎移植术(in vitro fertilization and embryo transfer,IVF-ET)后单胎妊娠孕妇早产的相关因素及新生儿结局。方法回顾性分析2013年8月至2015年8月在中山大学孙逸仙纪念医院分娩的250例孕产妇临床资料,其中IVF-ET后单胎妊娠早产组(A组)50例,自然妊娠单胎早产组(B组)100例,IVF-ET后单胎妊娠足月分娩组(C组)100例。记录妊娠期糖尿病、妊娠期高血压、胎膜早破、前置胎盘或低置胎盘发生率,以及新生儿结局等资料,分析IVF-ET术后单胎妊娠早产相关因素。记录和分析孕期因宫颈机能不全行宫颈环扎术操作的情况。结果妊娠期并发症、早产儿出生体重和分娩孕周,A组和B组差异无统计学意义。妊娠期高血压(A组14%、C组3%),胎膜早破(A组42%、C组14%),前置胎盘或低置胎盘(A组12%、C组2%),新生儿出生体重[A组(2225±622)g、C组(3231±482)g]、1 min Apgar评分[A组(8.61±1.77)分、C组(9.49±0.94)分],5 min Apgar评分[A组(9.66±0.94)分、C组(9.93±0.29)分],A组和C组比较差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示妊娠期高血压、胎膜早破、前置胎盘或低置胎盘、宫颈机能不全与IVF-ET术后单胎妊娠早产相关。孕期因宫颈机能不全,需行宫颈环扎术的患者,A组为22%,B组为9%,C组为4%,A组与B、C组比较差异均有统计学意义(P均<0.05)。结论妊娠期高血压、胎膜早破、前置或低置胎盘、宫颈机能不全是IVF-ET术后单胎妊娠早产的高危因素。IVF-ET术后单胎妊娠早产儿与足月儿相比,出生体重、1 min Apgar评分、5 min Apgar评分均较差。

Objective To investigate the related factors of preterm birth and neonatal outcomes in single pregnancy after in vitro fertilization and embryo transfer(IVF-ET).Method A retrospective analysis was conducted in 250 pregnant women in the Sun Yat-sen Memorial Hospital from August 2013 to August 2015.The patients were divided into preterm birth of single pregnancy after IVF-ET(group A,50 cases),preterm birth of single pregnancy after natural pregnancy(group B,100 cases)and full-term birth of single pregnancy after IVF-ET(group C,100 cases).By recording the incidence of gestational diabetes mellitus,gestational hypertension,premature rupture of membranes,placenta praevia or low-positioned placenta,as well as neonatal outcome,analyze the factors related to preterm delivery of single pregnancy after IVF-ET.Results There were no significant differences in pregnancy complications,birth weight of premature infants and gestational weeks between group A and group B.The incidences of gestational hypertension in group A and group C were(14%and 3%),premature rupture of membranes(42%and 14%),placenta praevia or low-positioned placenta(12%and 2%),birth weight of newborn[(2225±622)g and(3231±482)g],1 min Apgar score[(8.61±1.77)and(9.49±0.94)],5 min Apgar score[(9.66±0.94)and(9.93±0.29)],and the differences between the two groups were statistically significant(P<0.05).Logistic regression analysis showed that gestational hypertension,premature rupture of membranes,placenta praevia or low-positioned placenta,cervical incompetence were associated with preterm birth of single pregnancy after IVF-ET.The incidences of cervical cerclage in pregnancies due to cervical incompetence were 22%,9%and 4%in group A,group B and group C,respectively.There were significant difference between group A and group B,group C(P<0.05),respectively.Conclusions Gestational hypertension,premature rupture of membranes,placenta praevia or low-positioned placenta and cervical incompetence are high risk factors for preterm birth of single pregnancy after IVF-ET.The birth weight,Apgar score at 1 min and 5 min were all worse in preterm infants than in full term infants of single pregnancy after IVF-ET.