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目的探讨体外受精-胚胎移植术后双绒毛膜双胎(DCDA)之一自然减胎的发生率及其对妊娠结局的影响。方法回顾性分析2009年1月至2015年12月在中山大学附属第一医院行体外受精-胚胎移植的DCDA妊娠病例共4162例,其中双胎自然减灭一胎组745例;未发生自然减胎的3661例作为双胎对照组;同期单胎妊娠的14521个周期作为单胎对照组。首先描述双胎之一自然减胎的总体发生率以及其在不同孕周的发生率;然后比较其与双胎对照组、单胎对照组的临床妊娠结局;最后通过回归模型明确双胎之一自然减胎是否降低抱婴回家可能性的高危因素。结果双胎之一自然减胎的总体发生率为17.9%,其中绝大部分发生在早孕期。自然减胎组在流产率、早产率、活产率、抱婴回家率、分娩孕周及新生儿出生体重等各方面的结局指标均显著优于未发生自然减胎的双胎对照组;活产率、抱婴回家率和新生儿出生体重等主要结局与单胎对照组无明显差异。多因素回归分析结果显示,当未发生自然减胎时,抱婴回家的可能性显著下降(OR=0.73,P=0.008);自然减胎不是降低抱婴回家可能性的高危因素。结论自然减胎是体外受精-胚胎移植术后DCDA的常见现象。自然减胎对存活胎儿的影响不大,其临床结局良好,不降低抱婴回家的可能性。
Objective To investigate the incidence of spontaneous abortion and its effect on the outcome of pregnancy after double fertilization-embryo transfer (DCT). Methods A retrospective analysis of 4162 cases of DCDA pregnancy with in vitro fertilization and embryo transfer from January 2009 to December 2015 in the First Affiliated Hospital of Sun Yat-sen University was conducted. Among them, 3661 cases of fetuses as twins control group; 14521 cycles of singleton pregnancies in the same period as a singleton control group. First, describe the overall incidence of natural abortion of one of the twins and their incidence at different gestational weeks; then compare their clinical pregnancy outcomes with twin controls and singleton controls; and finally, identify one of the twins by regression Whether or not natural child abortion reduces the risk of having a baby go home is a risk factor. Results The overall incidence of natural abortion of one of the twins was 17.9%, most of which occurred in the first trimester. Natural abortion group in the abortion rate, premature birth rate, live birth rate, the rate of baby to go home, gestational birth and newborn birth weight and other aspects of the outcome indicators were significantly better than those without natural abortion twins control group; The main outcomes such as live birth rate, rate of arrival of newborns and newborn birth weight had no significant difference with singleton control group. Multivariate regression analysis showed that there was a significant decrease in the probability of having a baby go home (OR = 0.73, P = 0.008) when spontaneous abortion did not occur; natural abortion was not a risk factor for reducing the likelihood of having a baby go home. Conclusion Natural abortion is a common phenomenon of DCDA after in vitro fertilization-embryo transfer. The natural reduction of fetal survival of the fetus has little effect, its clinical outcome is good, does not reduce the possibility of having babies go home.