多胎妊娠减胎术对经体外受精-胚胎移植技术助孕女性妊娠结局的影响

目的 探讨经阴道多胎妊娠减胎术(MPR)对体外受精-胚胎移植(IVF-ET)助孕女性妊娠结局的影响.方法 选取2017年1月至2020年12月在安徽医科大学第一附属医院生殖医学中心就诊的336例经IVF-ET助孕获临床多胎妊娠且经多胎妊娠减胎术减至单胎妊娠的孕妇(多胎减胎组),以及同时期就诊于安徽医科大学第一附属医院生殖中心经IVF-ET助孕获临床单胎妊娠的336例孕妇(对照组).分别对多胎减胎组和对照组孕妇的妊娠结局、相关妊娠期并发症及新生儿结局情况进行统计分析.结果 多胎减胎组及对照组间流产率、早产率、剖宫产率差异无统计学意义(P>0.05);两组之间妊娠期糖尿病、妊娠期高血压疾病、前置胎盘、产后出血及新生儿相关疾病的发生率差异无统计学意义(P>0.05);多胎减胎组的胎膜早破发生率(7.74％)高于对照组(4.17％),差异有统计学意义(P<0.05);单因素logistic回归分析结果显示,MPR使妊娠期并发症的总体发生风险升高(OR值=1.516);调整年龄、身体质量指数(BMI)后,MPR发生妊娠并发症的总风险增加了1.549倍,发生胎膜早破的风险增加了2.013倍;无论是否调整年龄和BMI,MPR都没有增加妊娠期糖尿病、妊娠期高血压疾病、前置胎盘和产后出血的风险.结论 经阴道MPR会导致妊娠期并发症的发生风险增加.

Effect oftransvaginal multiple pregnancy reduction on pregnancy outcome of women assisted by in vitro fertilization and embryo transfer

Objective To investigate the effect of transvaginal multiple pregnancy reduction (MPR) on the pregnancy outcome of women assisted by in vitro fertilization and embryo transfer (IVF-ET). Methods From January 2017 to December 2020, 336 pregnant women who received clinical multiple pregnancy through IVF-ET and reduced to singleton pregnancy through multiple pregnancy reduction were selected (MPR group). And 336 singleton pregnancy women who received IVF-ET assisted pregnancy in the Reproductive Center of the First Affiliated Hospital of Anhui Medical University during the same period were selected as control group. The pregnancy outcome, related pregnancy complications and neonatal outcome were statistically analyzed in the MPR group and control group. Results There was no significant difference in abortion rate, premature delivery rate and cesarean section rate between the MPR group and control group (P>0.05). There was no significant difference in the incidence of gestational diabetes, gestational hypertension, placenta previa, postpartum hemorrhage and neonatal related diseases between the two groups (P>0.05). The incidence of premature rupture of membranes in MPR group was higher than that in control group (7.74% vs 4.17%), and the difference was statistically significant (P<0.05). Univariate logistic regression analysis showed that MPR increased the overall risk of pregnancy complications (OR=1.516). After adjusting for age and body mass index (BMI), the total risk of pregnancy complications in MPR increased 1.549 times, and the risk of premature rupture of membranes increased 2.013 times. Whether adjusted for age or BMI, MPR did not increase the risk of gestational diabetes, hypertensive disease during pregnancy, placenta previa, or postpartum bleeding. Conclusions Transvaginal multiple pregnancy reduction may increase the risk of pregnancy complications.