探讨多胎减胎术(MFPR)对体外受精(IVF)或卵胞浆内单精子注射(ICSI)三胎或双胎妊娠改善妊娠结局的效果及局限性。
我们对2002-2016年在生殖中心接受IVF或ICSI的女性进行了一项队列研究。妇女医院,浙江大学医学院.该队列包括502名接受MFPR的妇女和9641名未减少的妇女。妊娠结局是分娩时的胎龄(GA),怀孕失败,早产,低出生体重(LBW),极低出生体重(VLBW),小于胎龄(SGA)。采用多元线性回归和logistic回归模型比较各组妊娠结局。
减少到单胎的三胞胎具有更长的中位数GA(39.07vs37.00,P<0.001),低体重率(8.9%对53.2%,P<0.001)和SGA(17.8%vs44.7%,P=0.001)比三胞胎减少为双胞胎,妊娠损失率相似(6.7%对6.6%,P=0.701)。减少到单身的双胞胎的妊娠损失率相当(4.8%与6.5%,P=0.40),较长的中位数GA(38.79vs.37.00,P<0.001),和较低的LBW率(13.5%与47.0%,P<0.001)和SGA(13.5%vs.39.6%,P<0.001)比初生双胞胎。减少为双胞胎的三胞胎的LBW发生率更高(53.2%vs.47.0%,P=0.028)和SGA(44.7%vs.39.6%,P=0.040)比初生双胞胎,具有相似的妊娠损失率(6.6%vs.6.5%,P=0.877)。三胞胎/双胞胎减少的单胎早产率较高(15.8%vs.7.3%,P<0.001),LBW(12.3%与4.32%,P<0.001),VLBW(2.3%与0.4%,P=0.002),和SGA(14.6%对6.6%,P<0.001)比初级单身,具有相当的妊娠损失率(5.3%与5.4%,P=0.671)。
这项研究表明,减少组和不减少组的妊娠损失率相似。MFPR改善妊娠结局,包括早产的风险,LBW,还有SGA,但仍不能完全逆转多胎妊娠的不良妊娠结局.
To investigate the effectiveness and limitations of multifetal pregnancy reduction (MFPR) on the improvement of pregnancy outcomes of triplet or twin pregnancies conceived by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
We performed a cohort study of women undergoing IVF or ICSI from 2002-2016 in reproductive center, women\'s hospital, Zhejiang University School of Medicine. The cohort included 502 women who underwent MFPR and 9641 non-reduced women. Pregnancy outcomes were gestational age (GA) at delivery, pregnancy loss, preterm delivery, low birth weight (LBW), very low birth weight (VLBW), and small for gestational age (SGA). Multiple linear regression and logistic regression models were used to compare pregnancy outcomes between groups.
Triplets reduced to singletons had a longer median GA (39.07 vs 37.00, P<0.001), and lower rates of LBW (8.9% vs 53.2%, P<0.001) and SGA (17.8% vs 44.7%, P=0.001) than
triplets reduced to twins, with a similar pregnancy loss rate (6.7% vs 6.6%, P=0.701). Twins reduced to singletons had a comparable pregnancy loss rate (4.8% vs. 6.5%, P=0.40), a longer median GA (38.79 vs. 37.00, P<0.001), and lower rates of LBW (13.5% vs. 47.0%, P<0.001) and SGA (13.5% vs. 39.6%, P<0.001) than primary twins.
Triplets reduced to twins had higher rates of LBW (53.2% vs. 47.0%, P=0.028) and SGA (44.7% vs. 39.6%, P=0.040) than primary twins, with a similar pregnancy loss rate (6.6% vs. 6.5%, P=0.877). Singletons reduced from
triplets/twins had higher rates of preterm delivery (15.8% vs. 7.3%, P<0.001), LBW (12.3% vs. 4.32%, P<0.001), VLBW (2.3% vs. 0.4%, P=0.002), and SGA (14.6% vs.6.6%, P<0.001) than primary singletons, with a comparable pregnancy loss rate (5.3% vs. 5.4%, P=0.671).
This study suggests that the pregnancy loss rate is similar between reduction and non-reduction groups. MFPR improves pregnancy outcomes, including the risk of preterm delivery, LBW, and SGA, but still could not completely reverse the adverse pregnancy outcomes of multiple pregnancies.