辅助生殖技术后双胎妊娠自然减胎对妊娠结局的影响

Effects of spontaneous pregnancy reduction in twin pregnancy after assisted reproductive technology on pregnancy outcomes

目的比较辅助生殖技术双胎妊娠自然减胎与单胎的妊娠结局。方法回顾2008年1月1日至2017年12月31日北京大学第一医院辅助生殖技术双胎妊娠自然减胎121例,早期减胎95例(早期减胎组)及中期减胎26例(中期减胎组),同期320例单胎纳入对照组。对3组进行一般情况、早产及产科结局比较。结果中期减胎组新生儿出生体重低于早期减胎组及对照组[(2361.54±724.07)g、(3144.42±506.73)g、(3332.23±493.32)g],差异有统计学意义(P<0.05),而早产、新生儿窒息、转入NICU、低出生体重、胎儿生长受限及胎盘早剥发生率高于早期减胎组及对照组(P<0.05)。早期减胎组新生儿出生体重低于对照组,而早产率高于对照组(P<0.05)。3组凝血指标比较,差异无统计学意义(P>0.05)。结论辅助生殖技术自然减胎会导致新生儿出生体重下降及早产增加,中期自然减胎增加不良妊娠结局。

Objective To compare the pregnancy outcomes between the spontaneous reduction in twin pregnancy and the singleton pregnancy after assisted reproductive technology(ART).Methods A total of 121 cases of spontaneous reduction in twin pregnancy,who received ART at the Reproductive Center of Peking University First Hospital from January 1,2008 to December 31,2017,were included in the study,and were divided into early and middle spontaneous reduction groups with 95 and 26 cases in each group.Simultaneously,320 women with a singleton pregnancy were recruited as controls.Characteristics compared included the general condition of pregnant women,preterm birth as well as obstetric pregnancy outcomes.Results The overall birth weight in middle spontaneous reduction group was lower than that in early spontaneous reduction group and control group[(2361.54±724.07)g,(3144.42±506.73)g,(3332.23±493.32)g](P<0.05).Furthermore,higher rate of preterm birth,neonatal asphyxia,transfer to NICU,low birth weight,fetal growth restriction,and placental abruption rate was found in middle spontaneous reduction group than in early spontaneous reduction group and control group(P<0.05).The lower birth weight and higher rate of preterm birth were found in early spontaneous reduction group(P<0.05).However,no significant difference was found in coagulation indicators in 3 groups(P>0.05).Conclusion Spontaneous reduction under ART is associated with lower birth weight and higher incidence of premature delivery,whereas middle spontaneous reduction is associated with increased adverse pregnancy outcomes.