多胎妊娠减胎术对IVF-ET妊娠结局的影响

Analysis of pregnancy outcomes for multifetal pregnancy reduction underwent in vitro fertilization and embryo transfer

目的探讨在妊娠早期行多胎妊娠减胎术(multifetal pregnancy reduction,MFPR)是否影响体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVF-ET)妊娠结局。方法选自2008年1月~2018年12月在焦作市妇幼保健院生殖中心接受IVF-ET助孕的患者,对移植后出现多胎妊娠并于妊娠6~8w在我中心行经阴道B超引导胚胎抽吸术的222例患者的病例资料进行回顾性分析,根据减胎术后保留单、双胎将患者分为减为单胎组和减为双胎组,并选择同期在我院生殖中心行IVF-ET助孕后单胎、双胎妊娠的222例患者为对照组(未减胎组)。首先比较组间患者的年龄,不孕年限、体重指数(body mass index,BMI=体重/身高2(kg/m^(2))、移植日子宫内膜厚度、早期流产率、晚期流产率、分娩孕周、早产率、新生儿出生体质量、小于胎龄儿(Small for gestation,SGA出生体重低于同胎龄应有体重第10百分位数以下)、妊娠并发症率(包括妊娠期糖尿病、妊娠期高血压病)及新生儿出生缺陷率等。其次比较伴单绒毛膜双胎三胎妊娠减单绒毛膜双胎之一(A组)与异卵三胎妊娠保留双胎(B组)组间妊娠结局。结果①单胎组:减为单胎组与单胎组间一般助孕情况、妊娠结局及并发症率组间比较均无差异(P>0.05)。②双胎组:减为双胎组SGA率较非减胎组高,且差异具有统计学意义(P<0.05)。③A组自发性减胎率(spontaneous pregnancy reduction,SPR)高于B组,且差异具有统计学意义(P<0.05)。结论①多胎妊娠在妊娠早期减为单胎可以获得与单胎妊娠相近似的妊娠结局,并降低多胎妊娠带来的严重母婴并发症发生率。②多胎妊娠在妊娠早期减为双胎后有增加子代SGA风险。③较伴单绒毛膜双胎三胎妊娠减单绒毛膜双胎之一虽然增加SPR风险,但剩余单绒毛膜单胎均可获得健康子代,因此在某些特定情况下伴单绒毛膜双胎三胎妊娠减单绒毛膜双胎之一是可行的。

Objective:To investigate the influence of multifetal pregnancy reduction of pregnancy outcome in vitro fertilization and embryo transfer.Methods:A total of 444 patients under IVF-ET in our department from January 2008 to December 2018.we selected and clinical data and pregnancy outcome of 222 patients with multifetal pregnancy reduction were retrospectively analyzed.a total of 222 patients with twins/singleton pregnancy underwent IVF-ET without reduction were recruited as control groups.Accoding to the newborn amount.patient were divided into the singleton group and twin group,indicators including age,duration infertility,body mass index(BMI),endometriai thickness on the day embryo transfer,early abortion rate,late abortion rate,gestational age of delivery,birth weight,preterm birth rate,small for gestation rate,morbidity of pregnancy complications(including,gestational diabetes mellitus rate,gestational hypertension rate)and birth defects rate between two groups were compared.and the pregnancy outcomes of dichorionic triplet pregnancy which reduction one monchorionic twin(group A)with trichorionic triplet pregnancy which reduction to twins(group B)were compared.Results:①singleton group:general data and pregnancy outcome in two group had no significant different②twin group:SGA rate in the reduction twins group were higher than that in the no reduction twins group.③spontaneous pregnancy reduction rate in the A group were higher than B group.Couclusion:①multifetal pregnancy reduction can obtain similar pregnancy outcome as single pregnancy,and reduce the incidence of severe maternal and infant complications caused by multiple pregnancy.②SGA rate in the reduction twins group were higher than that in the no reduction twins group Group.③reduction one monchorionic twin group has increased the risk of spontaneous fetal loss,but the remaining monochorionic singletons could obtain healthy offspring.Therefore,it is feasible to reduction one monchorionic twin in some specific cases.