不同受孕方式双胎妊娠母胎的结局

Obstetrics and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously

目的研究不同受孕方式双胎妊娠母胎围产结局。方法回顾性分析双胎妊娠孕妇741例,根据受孕方式分为辅助生殖技术(assisted reproductive technology,ART)组(304例)和自然受孕组(437例),比较两组孕产妇妊娠相关资料和母胎结局情况;并分别比较单绒毛膜双羊膜囊双胎(ART组16例,自然受孕组185例)和双绒毛膜双胎(ART组245例,自然受孕组288例)不同受孕方式下母胎结局。结果ART组和自然受孕组孕妇中位年龄依次为32(30,35)岁和31(28,33)岁,初产妇所占比例依次为83.9%和46.3%,双绒毛膜双胎所占比例依次为94.7%和57.0%,产后出血发生率依次为41.2%和24.4%,剖宫产发生率依次为94.7%和89.0%,新生儿呼吸窘迫发生率依次为1.3%和3.0%,差异均有统计学意义(P<0.05)。两组间早产、妊娠期并发症、死胎、新生儿低出生体重等发生率和NICU入住率差异无统计学意义(P>0.05)。单绒双羊双胎两组间母胎结局差异均无统计学意义(P>0.05);双绒双羊双胎ART组产后出血发生率、剖宫产率显著高于自然受孕组(39.9%vs.23.7%,P<0.01;95.1%vs.87.8%,P<0.01),新生儿结局差异无统计学意义(P>0.05)。结论在双绒双胎中,ART受孕产后出血发生率高,应高度重视ART受孕双胎妊娠的围产期管理。

Objective To compare obstetrics and neonatal outcomes of twin pregnancy following assisted reproductive technology(ART)with spontaneous pregnancy.Methods 741 cases of twin pregnancy were retrospectively analyzed.They were enrolled in two groups,ART group(n=304)and spontaneous group(n=437).Obstetrics and perinatal outcomes were compared between the two groups.The obstetrics and neonatal outcomes of monochorionic twins(ART Group:16 cases;spontaneous group:185 cases)and double chorionic twins(ART Group:245 cases;spontaneous group:288 cases)were also compared.Results The ages of pregnant women in ART group and spontaneous group were 32(30,35)years and 31(28,33)years,respectively;the proportions of primiparas were 83.9%and 46.3%,respectively;the proportions of double chorionic twins were 94.7%and 57.0%,respectively;the incidences of postpartum hemorrhage were 41.2%and 24.4%,respectively;the incidences of cesarean section were 94.7%and 89.0%,respectively;and the incidences of neonatal respiratory distress were 1.3%and 3.0%.The differences were statistically significant.There was no significant difference in the incidence of premature birth,pregnancy complications,stillbirth,low birth weight or NICU occupancy rate between the two groups.There was no significant differences between groups in Monochorionic twins.The incidences of postpartum hemorrhage and cesarean section in the ART group of dichorionic twins were significantly higher than those of spontaneous pregnancy group(39.9%vs.23.7%,P<0.01;95.1%vs.87.8%,P<0.01).There was no significant difference in neonatal outcomes.Conclusion In dichorionic twins,the incidence of postpartum hemorrhage after ART conception is high,and perinatal management of ART conception twins should be paid more attention to.