孕早期行减胎术对胚胎移植助孕患者围产期母婴的影响

目的 探讨胚胎移植三胎妊娠后于孕早期行不同减灭数目减胎术对围产期母婴的影响。 方法 回顾性分析胚胎移植后三胎妊娠患者于孕早期行多胎妊娠减胎术后保留单胎和保留双胎共282例孕妇的资料,依据保留胎儿数将减胎组分为减至单胎组28例、减至双胎组254例。同时采用倾向性评分匹配法(PSM)与同期胚胎移植后未行减胎的单胎或双胎妊娠研究对象分别进行1∶3匹配。匹配完成后,共846例作为对照组,其中单胎对照组84例、双胎对照组762例。对4组患者的一般资料、妊娠结局、新生儿体质量及围产期并发症进行比较,并采用Logistic回归进一步做敏感性分析。 结果 (1)减胎组的流产率、晚期流产率、围产期并发症发生率高于对照组(P均<0.01),平均分娩孕周短于对照组(P=0.01),平均足月产儿体质量(P<0.01)、足月产率(P=0.016),剖宫产率(P=0.037)低于对照组;(2)减至单胎组剖宫产率低于减至双胎组(P=0.001),平均分娩孕周长于减至双胎组(P<0.01),平均足月产儿体质量高于减至双胎组(P<0.01);单胎对照组流产率、早期流产率、足月产率、足月产儿及早产儿体质量高于双胎对照组(P均<0.01),早产率低于双胎对照组(P<0.01)。 结论 妊早期行多胎妊娠减胎术并未增加早产、出生缺陷风险,但流产、围产期并发症及低体质量儿的发生风险增加。三胎妊娠后行多胎妊娠减胎术保留至单胎者比保留至双胎者,有更好的妊娠结局。

Effect of fetal reduction in early pregnancy on perinatal mothers and infants after embryo transfer

Objective To explore the effects of different number of fetal reduction in early pregnancy on perinatal mothers and infants after triplet pregnancy in embryo transfer. Methods The clinical data of 282 cycles of triplet pregnancy with fetal reduction after embryo transfer were retrospectively analyzed. According to the keeping number of fetus, the reduction group was divided into singleton group with 28 cycles and twin group with 254 cycles. The subjects of single or twin pregnancy who did not reduce the fetus after embryo transfer were matched with propensity score matching(PSM)and 846 cycles were enrolled as the control group, including 84 cycles in the singleton control group and 762 cycles in the twin control group. The general information, pregnancy outcomes, neonatal weight and perinatal complications of the 4 groups were compared, and Logistic regression was used to make further sensitivity analysis. Results (1)Compared with the control group, the reduction group had higher abortion rate, late abortion rate and perinatal complications rate(P<0.01); shorter gestational weeks(P=0.01); lower full-term birth weight(P<0.01), full-term birth rate(P=0.016), and cesarean section rate(P=0.037). (2)Compared with the twin group, the singleton group had lower cesarean section rate(P=0.001), longer gestational weeks(P<0.01), and higher full-term birth weight(P<0.01). Compared with the twin control group, the singleton control group had higher abortion rate, early abortion birth rate, full-term birth weight and premature birth weight(P<0.01), but lower preterm birth rate(P<0.01). Conclusion Fetal reduction in early pregnancy dose not increase premature birth rate or birth defect rate. However, it does increase abortion rate, risk of perinatal complications and low birth weight. The pregnancy outcome is better in patients with reduction of triplets to singletons than in those to twins.