辅助生殖多胎减胎后单胎妊娠与直接单胎妊娠结局比较

Assisted reproduction outcomes:direct singleton pregnancy vs.singleton pregnancy after reduction of mul⁃tiple pregnancies

目的 比较辅助生殖技术多胎减胎后的单胎妊娠与直接单胎妊娠的结局。方法 回顾性分析2013年1月至2020年12月于沈阳市妇婴医院接受辅助生殖助孕并成功妊娠的患者300例,分成3组:A组(单胎109例)、B组(B1组手术减胎91例、B2组自然减胎100例),比较各组妊娠期并发症、新生儿体质量差异。结果 B1组妊娠期并发症(97.8%)高于B2组(90%)和A组(75.2%),差异有统计学意义(P <0.05)。B1组妊高症(28.6%)高于A组(13.8%),差异有统计学意义(P <0.05);B1、B2组胎膜早破的发生率为36.3%、30%,高于A组(15.6%),差异有统计学意义(P <0.05);三组贫血发生率差异有统计学意义(P <0.05)。B组早产发生率明显高于A组(P <0.05);B1组低体质量(14.3%)显著高于A组和B2组(P <0.05)。孕<8周减胎B1组母儿并发症高于B2组(P <0.05);孕≥8周B2组早产发生率高于B1组(P <0.05)。结论 多胎减为单胎后妊娠期并发症、早产、新生儿低体质量高于初始单胎,因此减胎后应重视产前检查。手术减胎后母儿并发症高于自然减胎,建议在孕8~12周之间手术。建议年龄较高、首次移植者行单胚胎移植。

Objective To compare the outcomes of direct singleton pregnancy and singleton pregnancy after reduction of multiple pregnancies with assisted reproductive techniques.Methods Retrospective analysis was done to the data of 300 patients who received assisted reproduction and achieved successful pregnancy in our hospital from January 2013 to December 2020.Among them,109 cases with singleton pregnancy were assigned as group A,91 cases with singleton pregnancy by reduction of multiple pregnancies as group B1 and another 100 with singleton pregnancy for natural fetal loss of multiple pregnancies as group B2.The three groups were compared in terms of complications and neonatal weight.Results The rate of pregnancy complications in group B1(97.8%)was higher than that in group B2(90%)and significantly higher than in group A(P<0.05).Pregnancy hyperten⁃sion in group B1(28.6%)was significantly higher than that in group A(P<0.05).The incidences of premature rupture of membranes in the B1 and B2 groups(36.3%and 30%)were both significantly higher than that in group A(P<0.05).There were statistical differences in the incidence of anaemia among the three groups(P<0.05).The rate of preterm birth in group B was significantly higher than in group A(P<0.05).The rate of low weight(14.3%)in group B1 was significantly higher than that in group A and group B2(P<0.05).The rate of maternal and infant complications in B1 group at deduction of pregnancy<8 weeks was significantly higher than in group B2(P<0.05)and the rate of preterm birth in B2 group was higher than in B1 group at reduction of pregnancy≥8 weeks(P<0.05).Conclusion The rates of pregnancy complications,preterm birth and low neonatal weight among those with singleton pregnancy from reduction of multiple pregnancies are all higher than those among those with initial singleton pregnancy,and therefore prenatal examination should be emphasized after reduction.The rate of maternal and infant complications in those with reduction is higher than that in those for natural fetus loss,and therefore the reduction of multiple pregnancy is suggested between 8 and 12 weeks of gestation.Single embryo trans⁃fer is recommended for older women undergoing initial assisted reproduction.