妊娠方式对双胎妊娠母胎围产结局影响的研究

Effect of Pregnancy Methods on Perinatal Outcome of Twin Pregnancy

目的:探讨不同妊娠方式对双胎妊娠母胎围产结局的影响。方法:回顾性分析2019年1月—2023年1月在湖南师范大学附属长沙市妇幼保健院分娩的815例双胎孕产妇的临床资料,依据妊娠方式分为自然妊娠组(398例)和体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)组(417例),比较2组孕产妇基本资料、妊娠并发症及母胎围产结局。结果:IVF-ET组孕产妇年龄、分娩孕周、初产妇比例、多囊卵巢综合征比例、双绒毛膜双羊膜囊比例、妊娠期糖尿病发生率、剖宫产率、产后出血量和产后出血率均高于自然妊娠组,瘢痕子宫比例低于自然妊娠组(均P<0.05)。IVF-ET组新生儿早产率和转新生儿科率低于自然妊娠组,较大新生儿出生体质量高于自然妊娠组(均P<0.05)。结论:通过IVF-ET妊娠的双胎孕产妇围产期并发症发生率升高,需要严格把握胚胎移植的指征,严控移植的胚胎数目,加强围产期的管理,降低妊娠并发症的发生率,最大程度保障母婴安全。

Objective:To explore the impact of different pregnancy methods on the perinatal outcomes of twin pregnancies.Methods:A retrospective analysis was conducted on the clinical data of 815 twin pregnant women who gave birth at the Changsha Maternal and Child Health Hospital affiliated to Hunan Normal University from January 2019 to January 2023.They were divided into a natural pregnancy group(398 cases)and an in vitro fertilization-embryo transfer(IVF-ET)group(417 cases)based on the pregnancy mode.The basic information,pregnancy complications,and perinatal outcomes of the two groups were compared.Results:In IVF-ET group,the age of pregnant women,the gestational week of delivery,the proportion of primiparas,the proportion of polycystic ovary syndrome,the proportion of the dichorionic diamniotic,the incidence of gestational diabetes mellitus,the rate of cesarean section,the amount of postpartum hemorrhage and the rate of postpartum hemorrhage were higher than those in natural pregnancy group,and the proportion of scar uterus was lower than that in the natural pregnancy group(both P<0.05).The premature birth rate and transfer rate to neonatal department in the IVF-ET group were lower than those in the natural pregnancy group,while the birth weight of bigger infants was higher than that in the natural pregnancy group(both P<0.05).Conclusions:The incidence of perinatal complications increases in twin pregnant women who conceive through IVF-ET.It is necessary to strictly grasp the guidelines for embryo transfer,strictly control the number of embryos transferred,strengthen perinatal management,reduce the occurrence of pregnancy complications,and maximize the safety of mother and infant.