体外受精-胚胎移植后三胎妊娠的临床分析及预防

目的探讨体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)后三胎妊娠发生的原因及危害,为临床预防多胎妊娠提供依据。方法对我院2011年1月~2013年1月,行IVF或卵胞浆内单精子注射(ICSI)妊娠的36例三胎患者的临床资料及分娩情况进行回顾性分析。结果 (1)36例患者平均年龄(29.61±4.74)岁,≤37岁的患者占97.2%。(2)7例双卵三胎患者,年龄均≤35岁,其中6例为第一次胚胎移植,移植2枚胚胎;1例为重复周期移植,移植3枚胚胎。29例3卵三胎患者,均移植3枚胚胎。28例年龄≤37岁,22例为重复周期移植,6例为第一周期移植;仅1例3卵三胎患者,年龄为40岁,第一周期移植。(3)29例三胎患者孕早期因多胎妊娠行减胎术,无流产、感染等并发症的发生。(4)已分娩的26例患者,6例为单胎,17例为双胎,3例为三胎。3例双胎孕中期早破水,发生死产。多胎妊娠早产率高达53%。三胎分娩新生儿平均体重(2 175±278)g,明显低于双胎及单胎妊娠。结论 (1)IVF中,若患者年轻,年龄≤35岁,虽移植2枚胚胎,但仍有发生双卵三胎的较高风险,故以选择单胚胎移植为好。(2)患者较年轻,年龄≤37岁,移植3枚胚胎时,发生三卵三胎的风险较大,以两枚胚胎移植为好。(3)三胎妊娠早期行选择性减胎术可降低三胎分娩的发生,且是相对安全可靠的。(4)三胎妊娠易导致早产及新生儿低体重,应采取措施,杜绝三胎分娩的发生。

Clinical analysis and prevention of triplet pregnancy in IVF-ET

Objectives： To probe causes and harm of triplet pregnancy during in vitro fertilization（IVF）and provide advice for the clinical prevention of muhifetal pregnancy. Methods： A retrospective analysis on the clinical data and birth outcomes was applied to investigate 36 patients underwent IVF or ICSI with triplet pregnancy in our hospital. Results： The mean age of the 36 patients was（29.61±4. 74）years old,the patients under 37 years old were accounting for 97.22%. Among seven patients with dizygotic triplets and aged below 35 years old,6 patients were transferred two embryos in the first cycle and 1 patient was transferred three embryos in the repeated cycle. At the same time, 29 patients with trizygotic triplet were transferred three embryos, 22 patients were in the repeated cycle and 6 patients in the first cycle. Twenty eight patients were below 37 years old,and only one patient was 40 years old. Twenty nine patients with trizygotic triplets underwent muhifetal pregnancy reduction in early stage of pregnancy without complication in terms of abortion, infection etc. There were 6 singleton pregnancies, 17 twin pregnancies and 3 triplet pregnancies in 26 patients who had delivered. Rupture of membranes and stiilbirth occurred in 3 patients with twin pregnancies in the pregnant metaphase,and the rate of preterm birth in muhifetal pregnancy was 53%.The average weight of neonates from triplet pregnancy was （2 175 ± 278） g, which was stgnmcanrly lower than that from twin and triplet pregnancy. Conclusions： Despite two embryos transplanted,there was still a high risk of dizygotic triplets in the young patients aged below 35 years in IVF. Therefore,it is better to select single embryo transfer. For the younger patients aged below 37 years old,it is better to transplant two embryos to a~oid trizygotic triplets. The selective fetal reduction in early stage of triplet pregnancy could decrease the rate of triplet delivery, and waS relatively safe and reliable. The triplet delivery should be avoided because triplet pregnancy was likely to result in preterm labor and low birth weight in neonates.