Abstract：
OBJECTIVE: Is there an association between intrauterine haematoma (IUH) and pregnancy outcomes in patients who undergo fetal reduction after double embryo transfer (DET), and if so, what is the relationship between IUH-related characteristics and pregnancy outcomes?
METHODS: Clinical information and pregnancy outcomes of women who underwent fetal reduction after DET were analysed. Patients with other systematic diseases, ectopic pregnancy or heterotopic pregnancy, monochorionic twin pregnancies and incomplete data were excluded. Stratification of IUH pregnancies was undertaken based on IUH-related characteristics. The main outcome was incidence of fetal demise (<24 weeks), with other adverse pregnancy outcomes considered as secondary outcomes.
RESULTS: Thirty-four IUH patients and 136 non-IUH patients who underwent fetal reduction after DET were included based on a 1:4 match for age, cycle type and fertilization method. IUH patients had a higher incidence of early fetal demise (20.6% versus 7.4%, P = 0.048), threatened abortion (48.1% versus 10.3%, P<0.001) and postpartum haemorrhage (PPH; 14.8% versus 4.0%, P = 0.043) compared with non-IUH patients. IUH was an independent risk factor for early fetal demise [adjusted OR (aOR) 3.34, 95% CI 1.14-9.77] and threatened abortion (aOR 8.61, 95% CI 3.28-22.61) after adjusting for potential confounders. IUH pregnancies undergoing fetal reduction that resulted in miscarriage had larger IUH volumes and earlier diagnosis (both P < 0.03). However, IUH characteristics (i.e. volume, changing pattern, presence or absence of cardiac activity) were not associated with threatened abortion or PPH.
CONCLUSIONS: Fetal reduction should be performed with caution in IUH pregnancies after DET as the risk of fetal demise is relatively high. Particular attention should be given to IUH patients with early signs of threatened abortion and inevitable fetal demise.
METHODS: Clinical information and pregnancy outcomes of women who underwent fetal reduction after DET were analysed. Patients with other systematic diseases, ectopic pregnancy or heterotopic pregnancy, monochorionic twin pregnancies and incomplete data were excluded. Stratification of IUH pregnancies was undertaken based on IUH-related characteristics. The main outcome was incidence of fetal demise (<24 weeks), with other adverse pregnancy outcomes considered as secondary outcomes.
RESULTS: Thirty-four IUH patients and 136 non-IUH patients who underwent fetal reduction after DET were included based on a 1:4 match for age, cycle type and fertilization method. IUH patients had a higher incidence of early fetal demise (20.6% versus 7.4%, P = 0.048), threatened abortion (48.1% versus 10.3%, P<0.001) and postpartum haemorrhage (PPH; 14.8% versus 4.0%, P = 0.043) compared with non-IUH patients. IUH was an independent risk factor for early fetal demise [adjusted OR (aOR) 3.34, 95% CI 1.14-9.77] and threatened abortion (aOR 8.61, 95% CI 3.28-22.61) after adjusting for potential confounders. IUH pregnancies undergoing fetal reduction that resulted in miscarriage had larger IUH volumes and earlier diagnosis (both P < 0.03). However, IUH characteristics (i.e. volume, changing pattern, presence or absence of cardiac activity) were not associated with threatened abortion or PPH.
CONCLUSIONS: Fetal reduction should be performed with caution in IUH pregnancies after DET as the risk of fetal demise is relatively high. Particular attention should be given to IUH patients with early signs of threatened abortion and inevitable fetal demise.
摘要：
目的：双胚胎移植（DET）后胎儿减少患者的宫内血肿（IUH）与妊娠结局之间是否存在关联？如果是这样,IUH相关特征与妊娠结局之间有什么关系？
方法：分析DET后胎儿减少的临床资料和妊娠结局。患有其他系统性疾病的患者，异位妊娠或异位妊娠，单绒毛膜双胎妊娠和不完整数据被排除.IUH妊娠的分层是根据IUH相关特征进行的。主要结局是胎儿死亡的发生率（<24周），将其他不良妊娠结局视为次要结局。
结果：根据年龄1：4匹配，纳入了在DET后进行胎儿减少的34例IUH患者和136例非IUH患者，周期类型和施肥方法。IUH患者早期胎儿死亡的发生率较高(20.6%对7.4%,P=0.048),先兆流产(48.1%对10.3%，P<0.001）和产后出血（PPH；14.8%对4.0%，与非IUH患者相比，P=0.043）。IUH是调整潜在混杂因素后早期胎儿死亡[校正OR（aOR）3.34，95％CI1.14-9.77]和先兆流产（aOR8.61，95％CI3.28-22.61）的独立危险因素。导致流产的胎儿减少的IUH妊娠具有更大的IUH体积和更早的诊断（均P<0.03）。然而,IUH特性(即体积，改变模式，是否存在心脏活动）与先兆流产或PPH无关。
结论：DET后IUH妊娠应谨慎进行减胎术，因为胎儿死亡的风险相对较高。应特别注意早期先兆流产和不可避免的胎儿死亡的IUH患者。
方法：分析DET后胎儿减少的临床资料和妊娠结局。患有其他系统性疾病的患者，异位妊娠或异位妊娠，单绒毛膜双胎妊娠和不完整数据被排除.IUH妊娠的分层是根据IUH相关特征进行的。主要结局是胎儿死亡的发生率（<24周），将其他不良妊娠结局视为次要结局。
结果：根据年龄1：4匹配，纳入了在DET后进行胎儿减少的34例IUH患者和136例非IUH患者，周期类型和施肥方法。IUH患者早期胎儿死亡的发生率较高(20.6%对7.4%,P=0.048),先兆流产(48.1%对10.3%，P<0.001）和产后出血（PPH；14.8%对4.0%，与非IUH患者相比，P=0.043）。IUH是调整潜在混杂因素后早期胎儿死亡[校正OR（aOR）3.34，95％CI1.14-9.77]和先兆流产（aOR8.61，95％CI3.28-22.61）的独立危险因素。导致流产的胎儿减少的IUH妊娠具有更大的IUH体积和更早的诊断（均P<0.03）。然而,IUH特性(即体积，改变模式，是否存在心脏活动）与先兆流产或PPH无关。
结论：DET后IUH妊娠应谨慎进行减胎术，因为胎儿死亡的风险相对较高。应特别注意早期先兆流产和不可避免的胎儿死亡的IUH患者。
