【摘要】：目的探討體外受精-胚胎移植術(shù)后雙絨毛膜雙胎(DCDA)之一自然減胎的發(fā)生率及其對妊娠結(jié)局的影響。方法回顧性分析2009年1月至2015年12月在中山大學(xué)附屬第一醫(yī)院行體外受精-胚胎移植的DCDA妊娠病例共4162例,其中雙胎自然減滅一胎組745例;未發(fā)生自然減胎的3661例作為雙胎對照組;同期單胎妊娠的14521個周期作為單胎對照組。首先描述雙胎之一自然減胎的總體發(fā)生率以及其在不同孕周的發(fā)生率;然后比較其與雙胎對照組、單胎對照組的臨床妊娠結(jié)局;最后通過回歸模型明確雙胎之一自然減胎是否降低抱嬰回家可能性的高危因素。結(jié)果雙胎之一自然減胎的總體發(fā)生率為17.9%,其中絕大部分發(fā)生在早孕期。自然減胎組在流產(chǎn)率、早產(chǎn)率、活產(chǎn)率、抱嬰回家率、分娩孕周及新生兒出生體重等各方面的結(jié)局指標(biāo)均顯著優(yōu)于未發(fā)生自然減胎的雙胎對照組;活產(chǎn)率、抱嬰回家率和新生兒出生體重等主要結(jié)局與單胎對照組無明顯差異。多因素回歸分析結(jié)果顯示,當(dāng)未發(fā)生自然減胎時,抱嬰回家的可能性顯著下降(OR=0.73,P=0.008);自然減胎不是降低抱嬰回家可能性的高危因素。結(jié)論自然減胎是體外受精-胚胎移植術(shù)后DCDA的常見現(xiàn)象。自然減胎對存活胎兒的影響不大,其臨床結(jié)局良好,不降低抱嬰回家的可能性。
[Abstract]:Objective to investigate the incidence of spontaneous reduction of (DCDA) in twin chorionic twins after in vitro fertilization and embryo transfer (IVF) and its influence on pregnancy outcome. Methods from January 2009 to December 2015, 4162 cases of DCDA pregnancy underwent IVF and embryo transfer in the first affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. 3661 cases of spontaneous fetal reduction were used as twin control group, while 14 521 cycles of single pregnancy were used as single pregnancy control group. The total incidence of one of the twins and their incidence in different gestational weeks were described, and then the clinical pregnancy outcome was compared with that in the twin control group and the single pregnancy control group. Finally, the regression model is used to determine whether the natural reduction of twin pregnancy is a high risk factor for reducing the possibility of infantile delivery home. Results the overall incidence of one of the twins was 17.9, most of which occurred in the early pregnancy. The rate of abortion, premature delivery, live delivery, home delivery rate, gestational weeks of delivery and birth weight of newborns in the natural reduced fetus group were significantly better than those in the control group. There was no significant difference in the main outcomes of live birth rate, home delivery rate and birth weight between single child control group and single child control group. The results of multivariate regression analysis showed that the probability of home delivery decreased significantly (OR=0.73,P=0.008) when there was no spontaneous reduction of fetus, and that natural reduction was not a high risk factor to reduce the possibility of home delivery. Conclusion Natural fetal reduction is a common phenomenon of DCDA after in vitro fertilization and embryo transfer. Natural fetal reduction has little effect on surviving fetus, and its clinical outcome is good, and it does not reduce the possibility of infantile home.
【作者單位】： 中山大學(xué)附屬第一醫(yī)院生殖醫(yī)學(xué)中心;
【基金】：廣東省生殖醫(yī)學(xué)重點實驗室專項(2012A061400003) 中華醫(yī)學(xué)會臨床醫(yī)學(xué)科研專項資金-生殖醫(yī)學(xué)青年醫(yī)師研究與發(fā)展項目(16020410657)
【分類號】：R714.8

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