双胎未足月胎膜早破的处理

近20多年来，由于孕妇的年龄偏大和辅助生育技术的应用，双胎以及多胎妊娠的发生率逐渐增加。双胎妊娠比单胎妊娠发生早产和胎膜早破的风险更高。有资料研究表明，双胎妊娠的PROM发生率约7．1％，由于双胎胎儿体重较小，所以易发生新生儿败血症、肺发育不全、肾功能不全以及围生期新生儿死亡。特别是未足月胎膜早破（PPROM）发生的越早，临床处理越棘手。     

《2022年加拿大妇产科医师协会“双绒毛膜双胎妊娠管理”指南》要点解读

<正>在过去数十年中，由于孕妇生育年龄推迟及广泛应用辅助生殖技术(assisted reproductive technology,ART)，全球双胎出生率显著上升，在加拿大，该比率从1991年的2%升至2009年的3.14%。近年来，这一趋势已趋于稳定，到2018年为3.12%，约占所有活产婴儿3%^[1]。双胎妊娠和多胎妊娠是加拿大早产发生率增加的主要原因之一，双胎妊娠发生多种不良妊娠结局的风险较单胎妊娠明显增加，包括流产、早产、胎儿先天性异常、胎儿生长受限(fetal growth restriction,FGR)、妊娠期糖尿病、妊娠期高血压疾病、手术分娩和产后出血等。     

三胎以上妊娠18例临床分析

<正>随着促排卵药物及辅助生育技术(ART)的应用,多胎妊娠的发生率逐年上升,其早产和产科并发症的发生明显高于单胎及双胎妊娠,引起产科工作者极大的关注。自1993年1月-2002年6月,在我院分娩三胎以上妊娠18例,报道如下。     

辅助生育技术助孕失败后患者自然妊娠的相关因素分析

我国目前不孕症发生率约为11%,辅助生育技术助孕成功率仅为30%～40%.有研究发现,部分不孕症患者采用辅助生育技术助孕失败在间隔一段时间后,又发生自然妊娠[1],国内外文献对此报道较少.我们对本中心应用辅助生育技术助孕失败后又自然妊娠的患者的临床特征进行分析,以探讨辅助生育技术助孕失败后自然妊娠发生的相关因素,现将结果报道如下.     

双胎自发性早产预测及预防

随着辅助生殖技术的发展,双胎妊娠的发生率增加,早产的发生率也随之增加。有证据表明,超声检测宫颈长度和胎儿纤维蛋白测试可以预测双胎妊娠的自发性早产,但是到目前为止,没有任何有效的双胎妊娠的自发性早产的干预措施。本文对双胎自发性早产的预测和预防进行阐述。     

子宫内膜异位症在辅助生育中对妊娠结局影响的研究进展

子宫内膜异位症(endometriosis,EMs)对生育能力的影响原因是多种的,机制是叠加的,辅助生育技术改善了EMs患者的生育能力,但内异症也影响着辅助生育的妊娠结局。本文就近年有关EMs导致不育和反复流产的病理生理研究进展及合并内异症患者对辅助生育技术中妊娠结局的影响等方面做一综述,以提高对EMs对生育能力影响的认识,达到进一步改善诊治方法,提高妊娠率、减少自然流产率、降低妊娠并发症的目的。     

体外受精-胚胎移植妊娠后发生双肺粟粒性结核并早产一例分析

体外受精与胚胎移植及其相关辅助生殖技术的临床效果 ,在已获得普遍认同的基础上 ,现被广泛应用于临床。但与自然妊娠相比 ,辅助生育技术可给母亲或子代带来一定的近期或远期影响 ,对此 ,国内外已有较多的相关报道。本期刊登的 1例体外受精与胚胎移植妊娠后发生粟粒性肺结核并早产的病例 ,有一定的临床意义。该患者曾进行的腹腔镜检查显示有“盆腔结核”的特征 ,术前患者有“盆腔炎症”的症状和体征。如能重视这些情况 ,做进一步检查 ,重新复查病理切片 ,有可能明确诊断或发现潜在的问题并及时处理 ,就可能避免患者较长时间服用地塞米松 ,必要时延后辅助生殖治疗 ,从而避免此后发生的结局。该病例的发生 ,向我们提出了一个在应用辅助生育技术中屡被忽视的问题 ,即应重视、排除应用该项技术的禁忌证 ,特别是潜在的、有可能在进行该项技术的过程中所引发的问题 ,如轻微的盆腔炎症、结核、生殖系统的早期肿瘤等。卫生部颁布的《人类辅助生育技术规范》中明确指出 ,辅助生育技术的开展 ,既有其相应的适应证 ,也有一定的禁忌证。此应引起我们的高度重视。     

双胎早产的防治

<正>早产是产科最常见的并发症,早产中双胎妊娠占比达10%,而小于孕32周早产中双胎妊娠占比高达23%。近年来随辅助生殖技术的发展,双胎妊娠发生率呈明显上升趋势,约占总妊娠数的3%～4%,早产发生率也随着呈上升趋势。研究发现有54%双胎妊娠在孕37周以前分娩,32%双胎妊娠在孕35周以前分娩,9%在孕32周以前分娩[1]。据统计,我国2016年双胎早产的发生率达59.72%。早产是影响新生儿结局的重要因素,早产儿器官发育不够健全,1岁内死亡的     

双胎妊娠流产及早产——临床关注的问题

正近年来,随着辅助生殖技术的发展,双胎妊娠发生率明显上升,文献报道,双胎妊娠约占活产分娩数的3%以上~([1])。双胎妊娠是高危妊娠,如何提高双胎妊娠的孕期保健和管理质量是临床关注的问题。早产是双胎妊娠面临的重要问题,因早产导致的围产儿死亡率和致病率均明显上升。资料报道,双胎妊娠的平均分娩孕周为35.3周,23%的双胎妊娠会发生32周的早产~([2])。双胎妊娠孕期管理早产预测和预防、宫缩抑制剂应用等问题,一直是临床关注的焦点。一、孕期宫颈长度测量在双胎妊娠流产早产     

多胎妊娠经阴道减胎术35例的护理

促排卵药物的应用和辅助生殖技术的开展，为许多不孕不育患者带来了确切的效果，但同时又不可避免地带来了多胎妊娠的问题。多胎妊娠容易发生流产、早产、宫内发育迟缓且使孕产妇并发症增高。在妊娠期进行≥3胎减胎术，使多胎减为双胎或单胎既可以达到生育的目的，又可以消除多胎妊娠导致的不良后果…。现将我院生殖中心对：35例已有妊娠结局的≥3胎的多胎妊娠在孕早期经阴道行减胎术的结果及护理措施报告如下。     

The risk of birth defects in children born after assisted reproductive technologies

PURPOSE OF REVIEW: This review addresses the question of whether there is evidence of an increased risk of birth defects in children born following assisted reproductive technologies compared with spontaneously conceived children. RECENT FINDINGS: Three recent studies added relatively little new information given their modest size (56-472 assisted reproductive technology children). We therefore considered all published papers that compared birth defects in children born following assisted reproductive technologies with those in children born following spontaneous conception. Overall, only six of the 26 relevant papers concluded there was an increased risk of birth defects following assisted reproductive technologies. The interpretation of many studies was based on statistical significance testing alone. When results showed a greater proportion of defects in the assisted reproductive technology group compared with the spontaneous group, but the results were not statistically significant, this was often interpreted as showing no increase in risk, rather than an increase in risk that may have been due to chance. The vast majority of individual studies were too small to have sufficient power to detect, as statistically significant, clinically relevant results. We found that although only eight (30%) of the studies had statistically significant results, 24 (89%) had an odds ratio estimate comparing assisted reproductive technology with spontaneously conceived children of over 1.0; 19 (70%) had an estimate of 1.20 or greater; and 14 (52%) had an estimate of 1.5 or greater. SUMMARY: Current evidence suggests there is an elevated risk of birth defects in children born following assisted reproductive technologies. Whilst others may disagree with our interpretation, one certainly cannot exclude this possibility on the basis of the current evidence.     

高龄女性自然妊娠及辅助生殖技术子代的安全性

近年来,随着生育年龄的推迟,高龄妊娠不断增多,辅助生殖技术的需求不断增大,其子代安全性问题也越来越受到关注,相关研究亦逐渐增多。对于高龄妇女,如何降低子代出生缺陷、规避风险以达到优生目的的前提是了解高龄自然妊娠及辅助生殖技术可能造成的风险。文章将对高龄妇女自然妊娠与辅助生殖技术的子代安全性进行归纳总结。     

辅助生殖技术妊娠和宫颈机能不全

辅助生殖技术被广泛的应用于治疗不孕及反复妊娠丢失患者。与自然受孕者相比,辅助生殖技术助孕的患者发生晚期流产及早产风险增加,可能与多囊卵巢综合征、子宫畸形、复发性流产、反复宫腔操作、多胎妊娠等相关的宫颈机能不全有关。本文将对早期识别辅助生殖技术助孕妊娠宫颈机能不全的高危患者及辅助生殖技术助孕后妊娠宫颈机能不全的监测进行讨论。     

Effect of repeated assisted reproductive technology on ovarian response

PURPOSE OF REVIEW: Based on current rates of success, many infertile couples who desire pregnancy have to undergo repeated cycles of assisted reproductive technology. Concern has been raised that repeated cycles of assisted reproductive technology may have a detrimental effect on future ovarian response and function, as well as pregnancy. This review summarizes current knowledge of the effects of repeated assisted reproductive technology, highlighting recent publications. RECENT FINDINGS: The available published evidence so far indicates that the follicular response and the number of oocytes retrieved appears to be maintained with repeated treatment and the only significant decline in ovarian response is because of an increase in female age. Similarly pregnancy and live birth rates decline to a small degree only up to cycle 3 or 4, with increasing female age again being the prime determinant. Encouraging patients to undertake repeated treatment without undue delay leads to improved cumulative rates of pregnancy and live birth. Current evidence does not indicate that ovarian stimulation leads to an increased risk of ovarian malignancy. SUMMARY: Couples should be counselled from the outset that assisted reproductive technology treatment is a continuum and a number of treatment cycles may be necessary. At present, there is little indication that repeated cycles have a detrimental effect on ovarian function, although the outcome of further research is awaited.     

Economics may not explain Hispanic underutilization of assisted reproductive technology services

In a lower cost, equal-access-to-care setting, Hispanic use of assisted reproductive technology was less than half of what would have been expected based on patient demographics. Despite this use disparity, there were no significant differences between Hispanic and Caucasian women with regard to infertility diagnoses, assisted reproductive technology cycle parameters, clinical pregnancy rates, live birth rates, spontaneous abortion rates, and implantation rates.     

Congenital anomalies and assisted reproductive technology: more of the same

Klemetti's birth registry study is put in context of other major studies. Summary advice is offered to practitioners as to what they should tell parents who conceive with assisted reproductive technology.     

Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development workshop

The National Institute of Child Health and Human Development held a workshop on September 12-13, 2005, to summarize the risks for adverse pregnancy outcomes after assisted reproductive technology (ART), develop an approach to counseling couples regarding these risks, and establish a research agenda. Although the majority of ART children are normal, there are concerns about the increased risk for adverse pregnancy outcomes. More than 30% of ART pregnancies are twins or higher-order multiple gestations (triplets or greater) and more than one half of all ART neonates are the products of multifetal gestations, with an attendant increase in prematurity complications. Assisted reproductive technology singleton pregnancies also demonstrate increased rates of perinatal complications-small for gestational age infants, preterm delivery, and perinatal mortality-as well as maternal complications, such as preeclampsia, gestational diabetes, placenta previa, placental abruption, and cesarean delivery. Although it is not possible to separate ART-related risks from those secondary to the underlying reproductive pathology, the overall increased frequency of obstetric complications, including preterm birth and small for gestational age neonates, should be discussed with the couple. Significant gaps in knowledge were identified, and the basic science and clinical and epidemiologic research required to address these gaps is outlined.     

Assisted reproductive interventions and multiple birth

OBJECTIVE: To investigate the contributions of ovulation-inducing drugs and assisted reproductive technologies to multiple birth. METHODS: This historic prospective study was conducted in a cohort of 13,151 women who delivered after 20 weeks' gestation between October 1996 and December 1999. The study setting was a Colorado health maintenance organization. Cases were women who were pregnant as a result of exposure to treatment with either assisted reproductive technologies or ovulation induction in the absence of assisted reproductive technologies. The main outcome measure was multiple birth. RESULTS: There was a significant association between assisted conception and multiple birth. Compared with women with naturally conceived pregnancies, there was a 25-fold likelihood (95% confidence interval 18, 35, P <.001) of multiple birth among women exposed to any of those treatments. In the total cohort the proportion of multiple births attributable to those treatments was 33%. After adjusting for the use of assisted conception and other covariates, we found no association between advanced maternal age and multiple birth. CONCLUSION: In this cohort, assisted reproductive interventions were strongly associated with multiple birth. Although a higher proportion of older women sought assisted reproductive technologies, we did not find an independent relationship between advanced maternal age and multiple birth. The increasing number of multiple births attributable to assisted conception raises public health concerns regarding multiple gestation-related maternal and infant morbidities.     

Introduction: Application of genetic advances to assisted reproduction technologies

Assisted reproductive technologies are common, and successful, therapies to treat infertility. However, challenges in improving the success of assisted reproductive technology, broadening the availability and applicability of the technologies, and minimizing complications and risks continue to confront the field. The science of genetics, including epigenetics and affiliated branches, is undergoing an explosion in the development of new technologies and knowledge. These advances can and will improve and alter the practice of assisted reproductive technology.     

Assisted reproductive technology: both sides now

Over the last 2 decades, increased pregnancy success has been achieved by assisted reproductive technology (ART) at the expense of perinatal well-being from a corresponding rise in multiple births. Multiple pregnancies increase the risk of prematurity, low birth weight, and perinatal morbidity and mortality. Together with recent concerns about possible birth defects and long-term developmental sequelae, modern ART practice is increasingly scrutinized for such adverse perinatal outcomes. Hence, it is mandatory for infertility specialists to look at ART from both sides now--its success and its complications. This article summarizes the prevalence of multiple pregnancies, the risk of low birth weight and possible birth defects, and long-term developmental sequelae associated with ART and discusses some potential approaches to minimizing these perinatal complications. Reducing the number of embryos transferred is an immediate action that can minimize adverse perinatal outcomes associated with multiple births. Continuous refinements in ART techniques will allow the transfer of a single embryo with equivalent rates of pregnancy success leading to a healthy, singleton live birth.