新鲜胚胎移植术后并发重度卵巢过度刺激综合征患者的母婴结局分析

Maternal-fetal outcomes in patients with severe ovarian hyperstimulation syndrome after fresh embryo transfer

目的探讨新鲜胚胎移植术后并发重度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)对患者母婴结局的影响。方法采用回顾性队列研究,选择2018年1月至2018年12月期间在重庆市妇幼保健院妇产科就诊并行新鲜胚胎移植后并发重度OHSS的155例患者(OHSS组)以及同期行新鲜胚胎移植后未发生OHSS的366例临床妊娠患者作为对照(非OHSS组)。根据Mathur的OHSS时间分型标准,将OHSS患者分为早发型亚组:发生在取卵后9 d(包括9 d)以内;晚发型亚组:发生在取卵后10 d或10 d以上;按照临床妊娠个数分为单胎亚组与双胎亚组。分析比较各组间的母婴结局差异(主要指标)及临床指标差异(次要指标)。结果OHSS组中早发型亚组34例,晚发型亚组121例;单胎亚组80例,双胎亚组75例。非OHSS组中单胎亚组194例,双胎亚组172例。与非OHSS组相比,OHSS组患者的年龄更低[(29.99±4.02)岁比(31.85±3.62)岁,P<0.001],而获卵数更多[(11.62±4.17)个比(9.48±4.39)个,P<0.001]。在OHSS患者中,早发型亚组患者的卵巢大小[(7.95±1.46)cm]、胸水最大深度[(5.83±4.57)cm]、红细胞比积(hematocrit,HCT)[(44.59±4.85)%]、D-二聚体最高值[(2.87±1.84)mg/L FEU]、腹腔穿刺者占比[23.53%(8/34)]及住院时间[(12.91±6.64)d]均较晚发型亚组高[(7.26±1.41)cm,P=0.013;(3.69±4.20)cm,P=0.012;(42.03±4.53)%,P=0.005;(2.01±1.09)mg/L FEU,P<0.001;9.09%(11/121),P=0.023;(10.12±6.18)d,P=0.024],而获卵数、血清白蛋白(serum albumin,ALB)最低值、肝功能损害程度及胸腔穿刺者占比两组差异均无统计学意义(均P>0.05);OHSS组中单胎亚组与双胎亚组间的住院相关临床资料差异均无统计学意义(均P>0.05)。OHSS患者中早发型亚组与晚发型亚组的双胎率、活产率、产科并发症、剖宫产率、产后出血率及新生儿结局方面差异均无统计学意义(均P>0.05)。OHSS组与非OHSS组比较,两组间的双胎率、流产率、异位妊娠率、活产率差异均无统计学意义(均P>0.05);不论是单胎妊娠还是双胎妊娠,OHSS组与非OHSS组间的产科并发症、早产率、产后出血率及新生儿结局方面差异均无统计学意义(均P>0.05)。不论是OHSS还是非OHSS患者,双胎亚组较单胎亚组有更高的早产率[54.46%(116/213)比11.60%(29/250),P<0.001]、剖宫产率[96.71%(206/213)比74.00%(185/250),P<0.001]及低出生体质量儿率[59.39%(253/426)比5.20%(13/250),P<0.001]。结论新鲜胚胎移植后是否并发重度OHSS以及OHSS发生早晚对患者的远期妊娠并发症及母婴结局无明显影响;但重度OHSS发病越早,对母体造成的早期并发症更重,增添患者的经济负担及妊娠风险。多胎妊娠明显增加新生儿不良结局。

Objective To explore the impact of severe ovarian hyperstimulation syndrome(OHSS)after fresh embryo transfer on the maternal and neonatal outcomes of patients.Methods A respective cohort study was performed.Totally 155 patients with severe OHSS(OHSS group)treated in the Department of Obstetrics and Gynecology of Chongqing Health Center for Women and Children and received fresh embryo transfer in the Reproductive Center from January 2018 to December 2018 were selected,and 366 clinical pregnant patients without OHSS after transplantation served as control group(non-OHSS group).According to Mathur's OHSS time classification standard,OHSS patients were divided into early-onset subgroup,occurring within 9 d(including 9 d)after oocytes retrieved,and late-onset subgroup,occurring within 10 d or more after oocytes retrieved;according to the number of pregnancies,patients were divided into singleton subgroup and twin subgroup.The differences in maternal and neonatal outcomes(primary indicators)and clinical indicators(secondary indicators)were compared between the two groups.Results In OHSS group,34 early-onset and 121 late-onset,80 singletons and 75 twins were included and in non-OHSS group 194 singletons and 172 twins were included.Compared with non-OHSS group,patients in OHSS group had lower maternal age[(29.99±4.02)years vs.(31.85±3.62)years,P<0.001]and bigger number of oocytes retrieved(11.62±4.17 vs.9.48±4.39,P<0.001).For OHSS patients,compared with late-onset group,the ovarian size[(7.95±1.46)cm vs.(7.26±1.41)cm],depth of chest water[(5.83±4.57)cm vs.(3.69±4.20)cm],hematocrit(HCT)[(44.59±4.85)%vs.(42.03±4.53)%],D-dimer[(2.87±1.84)mg/L FEU vs.(2.01±1.09)mg/L FEU],percentage of patients undergoing abdominal puncture and hospitalization days[(12.91±6.64)d vs.(10.12±6.18)d]were higher in early-onset group(P=0.013,P=0.012,P=0.005,P<0.001,P=0.023,P=0.024),while the number of oocytes retrieved,serum albumin(ALB),level of liver enzyme and percentage of patients undergoing pleural puncture were not significantly different between the two groups(all P>0.05).The clinical data had no significant differences between singleton subgroup and twin subgroup(all P>0.05).The twins rate,the miscarriage rate,the ectopic pregnancy rate and the live birth rate were not significantly different between OHSS group and non-OHSS group(all P>0.05).There were no statistically significant differences in twin rate,live birth rate,obstetric complications,cesarean section rate,postpartum hemorrhage rate or neonatal outcomes between the early and late OHSS patients(all P>0.05).Whether in singleton pregnancy or twin pregnancy,the obstetric complications,preterm birth rate,postpartum bleeding rate and neonatal outcome were not significantly different between OHSS group and non-OHSS group(all P>0.05).Whether in OHSS or non-OHSS patients,the preterm birth rate[54.46%(116/213)],the cesarean section rate[96.71%(206/213)]and the low birth weight rate[59.39%(253/426)]were higher in twin subgroup than in singleton subgroup[11.60%(29/250),P<0.001;74.00%(185/250),P<0.001;5.20%(13/250),P<0.001].Conclusion The presentation and onset time of severe OHSS after fresh embryo transplantation had no adverse effect on the long-term pregnancy complications and pregnancy outcomes.Early-onset severe OHSS increased adverse effects on maternal in early pregnancy.Multiple pregnancies significantly increase the neonatal adverse outcomes.