体外受精-胚胎移植术后妊娠的系统管理及结局

Management system and outcome of pregnancies after in vitro fertilization and embryo transfer

目的 探讨体外受精 胚胎移植术 (IVF ET)后妊娠的系统管理方法及其对妊娠结局的影响。方法 回顾性分析在我院生殖医学中心行IVF ET、单精子卵胞浆内注射术 (ICSI)、冻融胚胎移植技术 (FET)的 374个妊娠周期的结局、围产儿情况及其管理方法。结果 374个妊娠周期中 ,生化妊娠 19例 (5 .0 8% ) ,临床妊娠35 5例 (94 .92 % )。继续妊娠 85例。失访 11例 ,失访率为 3.10 %。流产 5 8例 ,流产率为 16 .34% ;宫外孕 11例 ,占 3.10 % ;宫内外同时妊娠 6例 ,占 1.6 9%。分娩 190例 ,其中多胎分娩 6 9例 ,占 36 .32 %。早产 6 5例 ,占34.2 1%。出生新生儿 2 5 9例 ,其中早产儿 10 9例 ,占 4 2 .0 8%。新生儿死亡 2例 ,占 0 .77%。死胎 4例 ,占1.5 2 %。新生儿畸形 3例 ,占 1.16 %。与在外院分娩者比较 ,于我院检查、分娩的妇女在流产、宫外孕、宫内外同时妊娠方面的差异无显著性 (P >0 .0 5 ) ;在多胎分娩、妊娠高血压综合征、低体重儿方面的差异有显著性 (P <0 .0 5 )。我院未发生孕产妇死亡、死胎及新生儿死亡。结论 建立完善的定期跟踪随访制度 ,加强围产保健 ,严密监护、积极治疗 ,可有利于保证IVF ET术后妊娠妇女的健康及改善围产儿的预后。

Objective To appraise the method of management system on pregnancies after vitro fertilization and embryo transfer, and its effect on the outcome of pregnancies. Methods In our Reproductive Medical Center, 374 women were impregnated through in vitro fertilization and embryo transfer (IVF-ET), intracytoplasmic sperm injection (ICSI), and frozen-thawed embryo transfer (FET). A retrospective study on perinatal situations and its management afterwards were carried out on 374 pregnancies. At the same time, a comparison was made between 355 pregnant women in our hospital and other hospitals for check-up of obstetrical outcome, and perinatal situations. Results Among the 374 pregnancies, there were 19 biochemical pregnancies (5.08%), 355 clinical pregnancies (94.92%). There were 85 on-going pregnancies and 11 lost to follow-up (3.10%). There were 58 miscarriages (16.34%), 11 ectopic pregnancies (3.10%), and 6 heterotopic coexisting with uterine pregnancies (1.69%). Among the 190 deliveries, there were 69 multiple births (36.32%) and 65 premature births (34.21%). Among the 259 neonatal births, there were 109 preterm infant (42.08%), 2 neonatal deaths (0.77%), 4 fetal deaths (1.52%), and 3 with congenital malformations (1.16%). Comparing the pregnant women examined and delivered in our center with those from the other hospitals, there were no significant differences in miscarriages, ectopic pregnancies, and heterotopic coexisting with uterine pregnancies (P>0.05), whereas a significant difference could be observed in multiple births, pregnancy-induced hypertension, and low birth weight (P<0.05). There was no case of maternal death, fetal death, or neonatal death. Conclusions To protect the health of pregnant women after IVF-ET and to improve the prenatal situation, a routine closely follow-up system should be established for reinforcing the prophylactic perinatal care, seeking close monitoring, and giving active therapy.