辅助生殖技术受孕双绒毛膜双胎之一胎死宫内的存活儿围产期预后分析  

Analysis of perinatal risks for the surviving infant of dichorionic twins vanishing twin syndrome following assisted reproductive technology

作　　者：梅洁 孙彦欣 山惠枝 王俊霞[1] Mei Jie;Sun Yanxin;Shan Huizhi;Wang Junxia(Department of Reproductive Medicine,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院生殖医学科,南京210008 [2]南京大学医学院附属鼓楼医院妇产科,南京210008

出　　处：《中华生殖与避孕杂志》2022年第6期566-573,共8页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金面上项目 (82071646)。

摘　　要：目的探讨辅助生殖技术受孕的双绒毛膜双胎之一胎死宫内(single intrauterine fetal demise,sIUFD)存活儿的围产期结局。方法回顾性队列研究分析2013年1月至2018年12月期间在南京大学医学院附属鼓楼医院生殖医学科行冻融胚胎移植(frozen-thawed embryo transfer,FET)/新鲜胚胎移植的4922个周期(包括3116个FET周期的单胎活产周期和1806个新鲜胚胎移植周期的单胎活产周期)。其中新鲜周期的对照组纳入1000个单分裂胚移植后的单胎活产周期,消失双胎综合征(vanishing twin syndrome,VTS)组纳入806个双分裂胚移植后双绒毛膜sIUFD幸存儿单胎活产的VTS周期。冻融周期的对照组纳入2445个单胚胎移植(613例分裂胚和1832例囊胚)后单胎活产周期,VTS组纳入385个双分裂胚移植和286个双囊胚移植后双绒毛膜sIUFD幸存儿单胎活产的VTS周期。分别比较两组的基线资料,以及孕龄、出生体质量、早产率、低出生体质量率、小于胎龄儿率和先天畸形率等围产期结局的差异。结果在囊胚移植的冻融周期中,VTS组出生体质量低[(3316.82±617.69)g比(3405.16±550.68)g,P=0.013],低出生体质量的发生风险高[aOR(95%CI)=2.70(1.46~5.00),P=0.002],但在分裂胚移植周期中,VTS组和对照组围产期预后差异均无统计学意义(均P>0.05)。结论冻融周期囊胚移植后受孕的VTS幸存儿围产期风险升高,选择性单胚移植是改善辅助生殖技术受孕患者妊娠预后的关键。Objective To analyze the perinatal risks for the surviving infant of dichorionic twins vanishing twin syndrome(VTS)conceived by assisted reproductive technology(ART).Methods We used a retrospective cohort study to analyze the clinical data of 4922 frozen-thawed embryo transfer(FET)/fresh embryo transfer cycles in the Department of Reproductive Medicine of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2013 to December 2018.This study assessed 4922 cycles(3116 singleton live births from FET cycles and 1806 singleton live births from fresh embryo transfer cycles).The fresh embryo transfer cycles included 1000 singletons following cleavage-stage SET and 806 survivors of VTS following cleavage-stage double embryo transfer(DET).The FET cycles included 2445 singletons(613 cleavage-stage embryo transfer cycles and 1832 blastocyst transfer cycles)following single embryo transfer(SET)and 671 survivors of VTS(385 cleavage-stage embryo transfer cycles and 286 blastocyst transfer cycles)following DET.Baseline characteristics and obstetric outcomes,including gestational age,preterm birth,birth weight,low birth weight,and small-for-gestational-age were analyzed between the two groups.Results In frozen-thawed blastocyst transfer cycles,VTS group had lower birth weight[(3316.82±617.69)g vs.(3405.16±550.68)g,P=0.013]and higher risk of low birth weight[aOR(95%CI)=2.70(1.46-5.00),P=0.002]compared with control group,but no differences of perinatal outcomes were found between VTS and control groups in cleavage-stage tansfer cycles.Conclusion Surviving infant of dichorionic twins VTS may have higher perinatal risks in blastocyst-stage FET.Selective SET is recommended to obtain singleton pregnancies with a more favorable pregnancy outcome from ART.

关 键 词：生殖技术 辅助 消失双胎综合征 围产期结局 

分 类 号：R714[医药卫生—妇产科学]