IVF-ET后双绒毛膜双羊膜囊双胎妊娠经腹部减胎术后的妊娠结局分析

摘要

目的:探讨体外受精-胚胎移植(IVF-ET)术后双绒毛膜双羊膜囊(DCDA)双胎妊娠患者行减胎手术的必要性及其对妊娠结局是否有利.方法:选取2014年1月-2016年12月于中山大学附属第六医院生殖医学中心就诊的DCDA双胎妊娠患者共248例,其中经腹部减胎者(减胎组)59例,未减胎者(未减胎组)189例,统计分析2组间早产率、妊娠中期流产率、新生儿体质量、孕周的差异.结果:与DCDA双胎妊娠未减胎组比较,减胎组早产率降低(13.56％ vs.36.51％)[孕34～36+6周早产率(10.17％ vs.29.10％)、孕28～33+6周早产率(3.39％vs.7.41％)],低出生体质量率降低(14.55％ vs.53.63％),平均孕周延长[(38.29±2.55)周vs.(36.60±1.85)周],新生儿体质量增加[(2.92±0.58)kg vs.(2.40±0.42)kg].结论:经腹双胎妊娠减胎术有助于改善IVF-ET后DCDA双胎妊娠的新生儿预后.%Objective:To investigate the necessity and clinical outcomes of transabdominal multifetal reduction in those patients with dichorionic dianionic (DCDA) twin pregnancies after in vitro fertilization and embryo transfer (IVF-ET).Methods:A total of 248 DCDA twin pregnancies after IVF-ET were retrospectively analyzed,from Jan 2014 to Dec 2016.59 patients received the transabdominal multifetal reduction (the reduced group),and 189 did not (the nonreduced group).The rate of midterm abortion,preterm birth,birth weight and birth week were compared between two groups.Results:Compared with the nonreduced group,the reduced group had higher birth weight [(2.92±0.58) kg vs.(2.40±0.42) kg],longer birth weeks (38.29±2.55 vs.36.60±1.85),lower preterm birth rate (13.56％ vs.36.51％) [34～36+6 weeks (10.17％ vs.29.10％),28～33+6 weeks (3.39％ vs.7.41％)],and lower rate of low birth weight (14.55％ vs.53.63％).Conclusions:The transabdominal multifetal reduction is helpful to improve the clinical outcomes in those DCDA patients after IVF-ET.