机构地区:[1]郑州大学第三附属医院生殖中心,郑州450052
出 处:《中华生殖与避孕杂志》2023年第4期393-398,共6页Chinese Journal of Reproduction and Contraception
摘 要:目的分析体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)助孕双胚胎移植后,双绒毛膜双胎妊娠选择性减胎患者的围产期结局。方法回顾性队列研究分析2005年9月1日至2020年7月31日期间于郑州大学第三附属医院生殖中心行IVF/ICSI助孕移植2枚胚胎,获得单胎活产患者的临床资料。根据是否发生减胎分为3组:双绒毛膜双胎选择性减胎为单胎患者组(记为A组,n=80)、双绒毛膜双胎自然减胎为单胎患者组(记为B组,n=832)和单胎着床患者组(记为C组,n=6178)。以A组为参照组,分别与B组、C组以1∶4比例近似倾向性评分匹配(propensity score matching,PSM)后,分析A组与B组、C组的基线数据及围产期结局的差异。结果①PSM前,A与B组、C组间患者年龄、既往生育史、不孕类型、移植胚胎类型差异均存在统计学意义(均P<0.05);PSM后,B组为289例,C组为271例。A组与B组、C组间基线数据差异均无统计学意义(均P>0.05)。②PSM后,A组早产率[17.5%(14/80)]高于B组[8.7%(25/289),P=0.023],出生孕周[(38.18±1.98)周]低于B组[(38.64±1.83)周,P=0.034];A组早产率[17.5%(14/80)]和胎膜早破发生率[5.0%(4/80)]高于C组[7.7%(21/271),P=0.011;0.4%(1/271),P=0.002],出生孕周[(38.18±1.98)周]及出生体质量[(3253.07±475.73)g]低于C组[(38.85±1.47)周,P=0.002;(3384.89±479.54)g,P=0.029],差异均有统计学意义。结论IVF/ICSI助孕双胚胎移植后双绒毛膜双胎妊娠选择性减胎的围产期结局较差。多胎妊娠选择性减胎并非最佳补救措施,应采取选择性单胚胎移植策略,切实降低多胎妊娠率,改善母婴结局。Objective To investigate the perinatal outcome of selective fetal reduction of dizygotic twins pregnancies after double embryo transferred assisted by in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI).Methods The clinical data of patients with single birth who underwent IVF/ICSI after double embryo transferred from September 1,2005 to July 31,2020 in Reproductive Center of the Third Affiliated Hospital of Zhengzhou University were retrospectively analyzed.The patients were divided into three groups according to the occurrence of fetal reduction:80 cases of dizygotic twins to singleton by selective fetal reduction(group A),832 cases of dizygotic twins to singleton by spontaneous fetal reduction(group B),and 6178 cases of singleton(group C).Using group A as the reference,after approximately propensity score matching(PSM)with 1∶4 ratio,289 cases in group B and 271 cases in group C were obtained.The differences in baseline data and perinatal outcomes between group A and group B or group C were analyzed.Results 1)Before PSM,there were statistically significant differences in patients'age,previous fertility history,type of infertility,and stage of embryo transferred between group A and group B or group C(all P<0.05);after PSM,there were no statistically significant differences in baseline data between group A and group B or group C(all P>0.05).2)After PSM,the premature birth rate was higher in group A than in group B[17.5%(14/80)vs.8.7%(25/289),P=0.023]and the gestational weeks[(38.18±1.98)weeks vs.(38.64±1.83)weeks,P=0.034]were lower;group A had higher incidence rates of premature birth[17.5%(14/80)vs.7.7%(21/271),P=0.011]and premature rupture of membranes[5.0%(4/80)vs.0.4%(1/271),P=0.002]than those in group C,but gestational weeks[(38.18±1.98)weeks vs.(38.85±1.47)weeks,P=0.002]and birth weight[(3253.07±475.73)g vs.(3384.89±479.54)g,P=0.029]were lower.Conclusion Perinatal outcomes of selective fetal reduction of dizygotic twins pregnancies after assisted by IVF/ICSI were poor.Selective fetal re
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