240例重度卵巢过度刺激综合征患者妊娠结局分析

目的:分析重度卵巢过度刺激综合征(OHSS)妊娠结局及其影响因素。方法:对2010年1月—2016年9月南京医科大学第一附属医院生殖医学中心收治的240例妊娠合并重度OHSS患者的妊娠结局进行分析,以同期510例年龄、体质量指数(BMI)匹配的体外受精(IVF)后妊娠且未发生OHSS的患者为对照组。结果:(1)与对照组相比,重度OHSS组基础窦卵泡数(AFC)和抗苗勒管激素(AMH)水平明显升高,促排卵方案中长方案比例较高。重度OHSS组人绒毛膜促性腺激素(h CG)日雌激素水平明显升高,优势卵泡数及获卵数均高于对照组,差异有统计学意义(P<0.05)。(2)重度OHSS组平均移植胚胎数、双胎率高于对照组,分娩孕周及新生儿出生体质量均低于对照组,差异有统计学意义(均P<0.05);2组早产、妊娠期糖尿病(GDM)、妊娠期高血压疾病(PIH)、胎膜早破(PROM)的发生率差异无统计学意义(均P>0.05)。(3)对单胎妊娠及双胎妊娠的妊娠结局分别进行分析发现,2组GDM及PROM发生率、剖宫产率、新生儿出生体质量、分娩孕周、早产率比较,差异均无统计学意义(均P>0.05)。单胎重度OHSS组PIH的发生率与对照组比较差异无统计学意义(P>0.05),但双胎重度OHSS组PIH的发生率低于对照组,差异有统计学意义(P<0.05)。结论:重度OHSS妊娠后分娩孕周及出生体质量降低,可能与重度OHSS妊娠患者中双胎比例增高有关。控制新鲜周期移植胚胎数有利于减少OHSS的发生,改善OHSS患者妊娠结局。

Analysis of Pregnancy Outcome in 240 Patients with Severe Ovarian Hyperstimulation Syndrome

Objective：To analyze the pregnancy outcome of patients with severe ovarian hyperstimulation syndrome (OHSS) and the related risk factors. Methods：The pregnancy outcomes of 240 pregnant women with severe OHSS from January 2010 to September 2016 were analyzed. 510 pregnant women matched by age and body mass index (BMI) after in vitro fertilization (IVF) without OHSS were selected as the control group. Results：① Compared with the control group, the severe OHSS group had higher number of antral follicle count (AFC) and higher level of serum anti Mullerian hormone (AMH) and higher proportion of long-protocol used in ovulation induction. The level of estrogen on the hCG day in the severe OHSS group was significantly higher than that in the control group, and the numbers of dominant follicles and retrieved oocytes were higher than those in the control group (P＜0.05). ② The average number of embryos transferred and the twin rate in the severe OHSS group were higher than those in the control group, while the gestational weeks and birth weight of newborns were lower than those in the control group (all P＜0.05). There was no significant differences in the incidences of preterm delivery, gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH) and premature rupture of membranes (PROM) between the two groups (all P＞0.05). ③ Pregnancy outcomes of single pregnancy and twin pregnancy were analyzed respectively. There were no significant differences in the incidences of GDM and PROM, cesarean section rate, birth weight of newborn, gestational week of delivery and premature delivery rate between the two groups (all P＞0.05). There was no significant difference in the incidence of PIH in single fetus pregnancy between the two groups (P＞0.05). However, the incidence of PIH in twin pregnancy in the severe OHSS group was significantly lower than that in the control group (P＜0.05). Conclusions：The decreased gestational age and birth weight after severe OHSS pregnancy may be associated with the increased twin pregnancy ratio. Controlling the number of embryos transferred in the fresh cycles can effectively reduce the occurrence of OHSS, and can improve the pregnancy outcome of OHSS patients.