辅助生殖技术受孕和自然受孕双胎妊娠结局的临床比较

目的:探讨辅助生殖技术(ART)受孕双胎妊娠与自然受孕双胎妊娠围生期的结局。方法:回顾分析93例ART受孕双胎妊娠孕妇(研究组)的并发症、分娩方式及围产儿结局,并与同期自然受孕双胎(对照组)451例比较。结果:研究组孕妇平均年龄较高(32.5±3.6岁),分娩孕周较小(33.4±4.3周),住院时间较长(21.1±2.6天),与对照组相比(分别为27.8±3.2岁、35.6±4.1周、11.3±1.5天)差异有显著性(P<0.05)。研究组早产、妊娠期高血压疾病、胎膜早破、前置胎盘、羊水过多的发生率明显高于对照组,两者差异有显著性(P<0.05)。研究组双胎输血综合征明显少于对照组(P<0.01)。两组剖宫产率均在72%以上,差异无统计学意义。研究组新生儿出生体重低、新生儿畸形和新生儿转NICU率高,与对照组相比有统计学差异(P<0.05)。研究组双胎之一胎死宫内率低于对照组(P<0.01)。结论:ART受孕双胎并发症和不良新生儿结局风险大,加强ART受孕双胎妊娠并发症的防治和产前、产时监护,产儿科密切合作和新生儿护理具有重要意义。     

辅助生育技术受孕双胎与自然受孕双胎妊娠结局的分析

目的　探讨辅助生育技术受孕 (助孕 )双胎与自然受孕双胎围产期的结局。方法　选择 10 4例助孕双胎孕妇 (助孕组 )和 173例自然受孕双胎孕妇 (自然受孕组 ) ,比较两组孕妇一般情况、妊娠合并症、分娩情况和新生儿预后等方面的差异。结果　 (1)助孕组孕妇平均年龄 (31 2± 3 7)岁 ,自然受孕组孕妇为 (2 7 8± 3 5 )岁 ,两组比较 ,差异有显著性 (P <0 0 5 )。 (2 )助孕组孕妇早产 70例(6 7 3% ) ,自然受孕组孕妇早产 78例 (45 1% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。助孕组孕妇患妊娠期糖尿病或糖耐量异常 16例 (15 4 % ) ,自然受孕组孕妇仅 4例 (2 3% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。(3)助孕组孕妇剖宫产率为 76 0 % (79/10 4 ) ,明显高于自然受孕组的 6 5 3% (113/173)。(4)两组围产儿死亡率、畸形发生率和新生儿窒息率等比较 ,差异无显著性 (P <0 0 5 )。结论　助孕双胎孕妇年龄较大 ,早产率及妊娠期糖尿病或糖耐量异常发生率高 ;分娩方式以剖宫产为主。助孕双胎孕妇的围产儿结局与自然受孕双胎相似     

不同绒毛膜性自然受孕双胎围产结局分析

目的:回顾分析自然受孕双胎妊娠相关资料,探讨不同绒毛膜性双胎的围产结局。方法:选取2015年6月至2018年5月于福建医科大学附属福建省妇幼保健院产检和分娩(28周以上)的自然受孕双胎妊娠孕妇,其中单绒毛膜双胎(MCT组)321例,根据年龄、孕前体质量指数(BMI)1∶1对照原则,选取同期双绒毛膜双胎(DCT组)321例,分析两组围产结局的差异。结果:642例双胎孕妇的平均年龄为(29.03±4.53)岁,孕前BMI为(20.73±2.51)kg/m~2,分娩孕周平均为(35.58±2.21)周,新生儿平均出生体重为(2148.89±221.4)g。母、儿围产结局发生前五位的分别为:早产、贫血、胎膜早破、GDM和妊娠期高血压疾病;新生儿高胆红素血症、新生儿畸形、双胎出生体重不一致、小于胎龄儿和新生儿窒息。其中早产的发生率最高,为55.61%。MCT组的早产、34周早产、脐带帆状附着、双胎出生体重不一致的发生率高于DCT组,但新生儿畸形、新生儿高胆红素血症发生率低于DCT组,差异均有统计学意义(P0.05)。两组的妊娠期高血压疾病、胎膜早破、贫血、前置胎盘、胎盘早剥、一胎羊水过多、剖宫产率,以及新生儿窒息、小于胎龄儿、围产儿死亡发生率等方面比较,差异均无统计学意义(P0.05)。结论:单绒毛膜性双胎增加母儿不良妊娠结局的发生率,根据双胎绒毛膜性做好详细的孕期保健,对提高母儿围产结局具有重要意义。     

104例助生殖技术受孕的双胎妊娠和193例自然受孕的双胎妊娠的分析

为了评价助生殖技术 (ＡＲＴ)受孕的双胎妊娠的妊娠结果 ,作者设计了此回顾性研究。从 1996年 1月至 1997年 12月 ,在Ｌｉｓ产科医院有 12 992例分娩 ,所有 2 97例 (2 3% )大于或等于 2 4孕周的双胎分娩包括在此研究中。其中 ,10 4例为助生殖技术受孕和 193例为自然受孕的双胎妊娠。复习病历有关母亲和新生儿的记录 ,了解妊娠和围产期的结果。统计分析根据不同需要采用 χ2 检验 ,Ｆｉｓｈｅｒ精确检验 ,Ｓｔｕｄｅｎｔｔ-检验 ,变量分析和逻辑回归模型。结果 :10 4例ＡＲＴ受孕的为研究组 ,193例非ＡＲＴ受孕的为对照组。在对照组中又分为…     

试管婴儿双胎及自然妊娠双胎临床结局分析

目的分析试管婴儿双胎与自然受孕双胎的母婴结局。方法收集2009年1月至2014年4月在北京大学人民医院定期随诊并分娩、孕周≥28周的双胎产妇共418例,其中试管婴儿双胎产妇(IVF组)235例,自然受孕双胎产妇(NC组)183例,对所有产妇的年龄、妊娠期合并症、分娩方式、产时并发症、新生儿出生体重、新生儿出生缺陷及围产期结局等临床资料进行统计学分析比较。结果 IVF组产妇平均年龄、高龄初产、妊娠期糖尿病、前置胎盘及产后出血发生率高于NC组(P0.05);IVF组双胎输血发生率显著低于NC组(P0.05);两组新生儿在出生体重、出生缺陷发生率、围产儿结局等方面比较差异均无统计学意义(P0.05)。结论与自然妊娠双胎相比,试管婴儿双胎妊娠不增加围产儿并发症与出生缺陷的风险,但IVF组母亲平均年龄大,高龄初产比例高,妊娠期糖尿病、前置胎盘、产后出血发生率高,因此试管婴儿双胎妊娠的产妇在妊娠期间需加强孕期保健。     

不同受孕方式双胎妊娠孕妇妊娠结局分析

目的:研究辅助生殖技术对双胎妊娠母儿结局的影响。方法:选择2014年1月至2018年12月于延安大学附属医院产科诊治的291例双胎妊娠产妇,根据受孕方式分为辅助生殖组(116例)和自然受孕组(175例),比较两组孕产妇妊娠相关资料和母儿结局情况。结果:辅助生殖组的平均年龄高于自然受孕组[(31.8±4.5)岁vs (29.2±5.3)岁,P0.001],初产比例高于自然受孕组(87.1%vs 73.7%,P=0.006);两组孕前体重指数(BMI)、绒毛膜性以及分娩方式构成比比较,差异均无统计学意义(P0.05)。辅助生殖组的足月产率低于自然受孕组(31.9%vs 45.1%,P=0.024),GDM和产后出血发生率高于自然受孕组(35.3%vs 16.6%,P0.001;15.5%vs 8.0%,P=0.045)。两组的子痫前期、妊娠期肝内胆汁淤积症(ICP)、胎盘早剥、前置胎盘、输血和子宫切除情况比较,差异均无统计学意义(P0.05)。两组的新生儿出生体重、新生儿窒息、病理性黄疸以及感染发生率比较,差异均无统计学意义(P0.05)。结论:与自然受孕组相比,辅助生殖组的平均年龄、初产比例高,早产率、GDM和产后出血发生率高;应高度重视辅助生殖受孕双胎妊娠产妇的孕期保健和围产期处置,减少母儿不良妊娠结局的发生。     

辅助生殖技术后双胎妊娠自然减胎对妊娠结局的影响

目的比较辅助生殖技术双胎妊娠自然减胎与单胎的妊娠结局。方法回顾2008年1月1日至2017年12月31日北京大学第一医院辅助生殖技术双胎妊娠自然减胎121例,早期减胎95例(早期减胎组)及中期减胎26例(中期减胎组),同期320例单胎纳入对照组。对3组进行一般情况、早产及产科结局比较。结果中期减胎组新生儿出生体重低于早期减胎组及对照组[(2361.54±724.07)g、(3144.42±506.73)g、(3332.23±493.32)g],差异有统计学意义(P0.05),而早产、新生儿窒息、转入NICU、低出生体重、胎儿生长受限及胎盘早剥发生率高于早期减胎组及对照组(P0.05)。早期减胎组新生儿出生体重低于对照组,而早产率高于对照组(P0.05)。3组凝血指标比较,差异无统计学意义(P0.05)。结论辅助生殖技术自然减胎会导致新生儿出生体重下降及早产增加,中期自然减胎增加不良妊娠结局。     

辅助生殖技术治疗后97例受孕妇女的妊娠结局

目的 探讨采用辅助生殖技术(ART)后受孕妇女的妊娠结局。方法 对1999年1月至2002年8月间接受辅助生殖治疗后妊娠的97例临床资料进行回顾性分析，研究ART者的妊娠结局。结果 ART者发生流产率23．71％(23／97)，异位妊娠6．19％(6／97)，多胎24．64％(17/69)，早产17．65％(12/68)，分娩方式以选择性剖宫产者较多，占58.82％(40／68)．新生儿结局良好，低体重儿比例高，占29．76%(25/84)。结论 经辅助生殖技术治疗后受孕的妇女病理妊娠发生率增高，为高危孕妇，故要予以高度重视，加强监护。     

不同绒毛膜性双胎围产结局717例临床分析

目的:探讨不同绒毛膜性双胎围产结局,为临床诊疗工作和后续科学研究的开展奠定基础,明确重点方向。方法:回顾性分析2008年1月至2017年3月在西安交通大学第一附属医院产科住院分娩的双胎妊娠病例共717例,其中单绒毛膜双胎206例(单绒毛膜组),双绒毛膜双胎511例(双绒毛膜组)。对两组的基本情况、母体结局和围产儿结局进行比较,并采用非条件Logistic逐步回归模型进行绒毛膜性对双胎不良围产结局影响的多因素分析。结果:①提供不同绒毛膜性双胎终止妊娠孕周和出生体质量的分布情况图,单绒毛膜组中在孕28～36~(+6)周终止妊娠的占67.96%,双绒毛膜组中占58.51%。单绒毛膜组中大儿体质量集中在2000～3000 g占72.78%,小儿体质量集中在1500～2500 g占65.68%;双绒毛膜组中分别占70.27%和64.66%。②不同绒毛膜性双胎的母体并发症发生率差异均无统计学意义(P0.05),与双绒毛膜组比较,单绒毛膜组自发性早产率较高、入院孕周、终止妊娠孕周均较早,差异均有统计学意义(P0.05)。③单绒毛膜性是发生双胎之一死亡(OR 2.82,95%CI 1.41～5.64)、体质量不一致性≥25%(OR 2.00,95%CI 1.19～3.37)以及极低或超低体质量儿(OR 2.40,95%CI 1.26～4.59)的独立危险因素(P0.05)。结论:相比于母体结局,绒毛膜性对围产儿结局的影响更大,单绒毛膜性是双胎不良围产儿结局的危险因素,临床管理中应重视对绒毛膜性的判定以及对单绒毛膜双胎围产期的监测,以尽可能改善单绒毛膜双胎的围产结局。     

双胎妊娠合并完全性前置胎盘的临床特征及围产结局

目的:探讨双胎妊娠合并完全性前置胎盘（complete placenta previa,CPP）的临床特征以及围产结局。方法:2012年1月至2020年12月在北京大学第三医院分娩的双胎妊娠2 937例,回顾性分析其中合并CPP的孕妇62例（双胎组）与同期分娩的单胎妊娠合并CPP的孕妇204例（单胎组）的临床资料。采用...     

Analysis of 104 twin pregnancies conceived with assisted reproductive technologies and 193 spontaneously conceived twin pregnancies

OBJECTIVE: To evaluate pregnancy outcome of assisted reproductive technology (ART)-conceived twin pregnancies. DESIGN: Retrospective study. SETTING: A tertiary obstetric care center. PATIENT(S): All twin pregnancies delivered > or = 24 weeks of gestation from January 1, 1996, to December 31, 1997. INTERVENTION(S): Maternal and neonatal record review. MAIN OUTCOME MEASURE(S): Pregnancy and perinatal outcome. RESULT(S): The study group comprised 104 ART-conceived twin pregnancies, and 193 non-ART-conceived pregnancies served as controls. Mean maternal age, the proportion of nulliparae, and the percentage of women who delivered before 34 weeks' gestation was higher among the study women, whereas mean gestational age was younger. The incidences of pregnancy-induced hypertension, uterine bleeding, premature contractions, intrauterine growth retardation, fetal death, discordance, and cesarean section were significantly higher in the study group. Correspondingly, in the study group, the mean birth weight of both twins was lower; more neonates weighed < 1, 500 g, more had Apgar scores of < 7 at 5 minutes, more were admitted to the intensive care unit, and more second twin neonates died. The outcome of twin pregnancies conceived spontaneously was comparable with those conceived by ovulation induction. CONCLUSION(S): Assisted reproductive technology-conceived twin pregnancies are at greater risk than non-ART-conceived ones for pregnancy complications and adverse perinatal outcome.     

Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study

Objective

To compare the obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproduction technology (ART) with spontaneously conceived (SC) twin pregnancies.

Study design

A prospective cohort study compared all dichorionic twin pregnancies in nulliparous women following fresh in vitro fertilization/intra-cytoplasmic sperm injection (ICSI) or ICSI cycles at Royan Institute (n = 320) with SC dichorionic twin pregnancies in nulliparous women at Arash Women's hospital (n = 170) from January 2008 to October 2010. These pregnancies were followed-up until hospital discharge following delivery. Obstetric and neonatal outcomes of SC and ART twin pregnancies were compared.

Results

Multivariate analysis, adjusted for maternal age and body mass index, revealed that the obstetric outcomes were similar in both groups. However, the risks of very preterm birth [odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1–12.9], extremely low birth weight (OR 2.2, 95% CI 1.0–3.9), admission to a neonatal intensive care unit (OR 2.0, 95% CI 1.2–3.2) and perinatal mortality (OR 2.3, 95% CI 1.2–4.0) were higher in the ART group.

Conclusions

The maternal outcomes of ART dichorionic twins were comparable with those of SC twins. However, despite the same obstetric management, the rates of very preterm birth, extremely low birth weight, admission to a neonatal intensive care unit and perinatal mortality were significantly higher in the ART group.     

Morphologic and histopathologic characteristics of placentas from twin pregnancies spontaneously conceived and from reduced and nonreduced assisted reproductive technologies

OBJECTIVE: To prospectively evaluate morphologic and histopathologic characteristics of placentas from twin pregnancies obtained by assisted reproductive technologies (ART) and non-ART and to evaluate the influence of previous fetal reduction on placental features. STUDY DESIGN: Fifty-five placentas from consecutive deliveries of ART-obtained and 50 placentas from consecutive deliveries of non-ART-conceived twin pregnancies were investigated by one pathologist, who was blinded to specimen origins. The patients' demographic and clinical data were also recorded. RESULTS: The mean maternal and gestational ages were similar in both groups. ART-obtained pregnancies were associated with an increased incidence of pregnancy complications and lower mean birth weight. Placentas from ART-obtained pregnancies were mostly of the dichorionic type and were thinner, weighed less and had more infarctions as compared to non-ART-conceived pregnancies. Placental characteristics of reduced ART-obtained twin pregnancies were comparable to those of nonreduced ones. The second twin's placenta in all groups weighed less and had a higher incidence of anomalous umbilical cord insertion. CONCLUSION: Placentas from ART-obtained twin pregnancies appear to have more pathologic features as compared to those of non-ART-conceived ones. Fetal reduction does not significantly affect the remaining placentas.     

Comparison of second trimester biometry in singleton and twin pregnancies conceived with assisted reproductive techniques

The objective of this study was to investigate the size of singleton vs twin pregnancies at the time of a second trimester dating scan. The analysis included 86 infants from 63 pregnancies achieved with assisted reproductive techniques, comprising 40 singletons and 46 twins. Measurements of second trimester biparietal diameter ( n = 85) and femur length ( n = 74) were plotted against the precisely known gestational age. A common regression line was calculated for each parameter and the residuals for singletons and twins were compared. Gestational age and weight at birth were also analysed for each group. There was no significant difference between singletons and twins in biparietal diameter or femur length in second trimester. In contrast, twins had a lower mean birthweight, gestational age at birth, and weight-for-gestational age centile compared with singletons. Singleton babies from these pregnancies had an average birthweight centile of 49.8% (i.e. close to the median for spontaneously conceived pregnancies in our population). We concluded that the same pregnancy dating charts can be used for singletons and twins. At corresponding gestational age, twins are smaller than singletons at birth because of slower growth in the third trimester.     

Early fetal reduction to twin versus prophylactic cervical cerclage for triplet pregnancies conceived with assisted reproductive techniques

Objective

To compare the obstetric outcomes of triplet gestations managed by early fetal reduction to twins with those managed by prophylactic cervical cerclage in women conceived with assisted reproductive techniques (ART).

Comparison of the outcomes of primary twin pregnancies and twin pregnancies following fetal reduction

High-order multifetal pregnancy is an inevitable consequence of assisted reproduction; and is associated with an increase in perinatal morbidity and mortality. Fetal reduction appears to be a safe and efficacious method for improving obstetric outcome. We made a retrospective study of study population 54 high multiple pregnancy following assisted reproduction that were reduced to twins at Shin Kong Memorial Hospital, Taipei,Taiwan from September 1992 to March 2000. Our study compares the outcome of multifetal pregnancy reduced to twins with the outcome of primary twin pregnancy. Maternal age, birth weight, gestational age at delivery and the incidence of preterm contractions were the only statistically significant differences between the two groups.