选择性减胎可以明显改善多胎妊娠的临床妊娠结局  

Multifetal pregnancy reduction improves clinical pregnancy outcome of multiple pregnancies

作　　者：孟庆霞[1] 吴惠华 李建芬 陈冰[1] 邹琴燕[1] 李红[1] 

机构地区：[1]南京医科大学附属苏州医院/苏州市立医院生殖与遗传中心,苏州215002

出　　处：《生殖医学杂志》2017年第10期1035-1040,共6页Journal of Reproductive Medicine

基　　金：江苏省苏州市卫生局项目(lczx201411);江苏省苏州市临床医学中心项目(szzx201505)

摘　　要：目的回顾性分析在本中心行IVF-ET获临床妊娠患者的妊娠结局,结合选择性减胎术(MFPR)患者的手术情况及妊娠结局,分析选择性减胎术的有效性和必要性。方法对本中心2008年4月至2016年4月共2 923例通过IVF-ET获得临床妊娠的患者进行跟踪随访,了解其孕期情况、分娩方式及新生儿健康状况等;同时对同期在本中心行MFPR的患者共130例随访,包括术后4周流产、晚期流产及早产等情况。MFPR患者来源包括行辅助生殖技术(ART)助孕获得的多胎妊娠以及单纯使用促排卵药物导致的多胎妊娠。结果 (1)IVF-ET患者的临床妊娠率51.52%,其中双胎妊娠率26.03%,三胎及以上妊娠率1.23%;双胎妊娠组晚期流产率和早产率均显著高于单胎妊娠组(P<0.001),且妊娠期贫血、妊高征、糖尿病和低出生体重儿的发生率均显著高于单胎妊娠组(P<0.001)。(2)130例MFPR患者中85.71%的四胎及以上妊娠由单纯使用促排卵药物导致;减胎时平均妊娠天数60.55d(49~126d),术后4周流产率为3.10%且全部发生于术后一周内,晚期流产率7.41%,早产率1.85%。(3)MFPR后低出生体重儿发生率显著低于IVF双胎妊娠未减胎组(P<0.001);IVF双胎妊娠经MFPR后早产率显著低于双胎妊娠未减胎组(P<0.001);IVF三胎妊娠经MFPR后无论减为双胎妊娠还是减为单胎妊娠,早产率均显著低于双胎妊娠未减胎组(P<0.05)。结论双胎妊娠的不良妊娠结局增加;四胎及以上多胎妊娠的主要原因是单纯促排卵药物的使用;MFPR可以降低多胎妊娠的早产率和低体重儿的发生率,改善因辅助生殖技术及促排卵药物导致的多胎妊娠的临床妊娠结局,作为助孕并发症的补救措施是行之有效的,也是非常有必要的。Objective: To study the effectiveness and necessity of multifetal pregnancy reduction(MFPR).Methods: The data of 2 923 pregnancy patients undergone IVF-ET between April 2008 and April2016 were retrospectively analyzed,and their pregnancy status,delivery and neonatal health etc.were followed up.At same time,130 patients undergone multifetal pregnancy reduction(MFPR)were followed up to collect the information including spontaneous abortion in 4 weeks after surgery,late abortion and premature birth etc.The multiple pregnancies patients who underwent MFPR were received the assisted reproductive technology(ART)or used ovulation induction drugs.Results:(1)The clinical pregnancy rate was 51.52%,the twins rate 26.03%,and the rate of triplets or more than three pregnancies 1.23%in IVF-ET group.The rates of late abortion and premature birth in twins group were significantly higher than in singleton group(P<0.001).(2)85.71% patients with four pregnancies were caused by using ovulation induction drugs alone.The average gestation time was 60.55days(49-126days)at MFPR.Abortion rate was 3.10%,and 100% occurred within one week after the surgery.Late abortion rate was 7.41%and premature birth rate was 1.85%.(3)The incidence of low birth weight after MFPR was significantly lower than that of twin pregnancy without MFPR in IVF group(P<0.001).Premature birth rate in twin pregnancy after MFPR was significantly lower than that of twin pregnancy without MFPR in IVF group(P<0.001).The premature birth rate in the patients with triplet pregnancy who underwent MFPR to reduce the multiple to twin pregnancy or single pregnancy was significantly lower than that of twin pregnancy without MFPR in IVF group(P<0.05).Conclusions: The adverse pregnancy outcome is increased in twins group.The main reason offour pregnancies is usage of ovulation induction drugs alone.MFPR can reduce the rate of preterm birth and low birth weight of multiple pregnancies and improve the clinical outcome of multiple pregnancies due to assisted reproductive technology

关 键 词：多胎妊娠 体外受精-胚胎移植 选择性减胎术 妊娠结局 

分 类 号：R[医药卫生]