目的:评估妊娠早期(≤12周)绒毛膜下出血(SCH)之间的关系,以及在辅助生殖技术(ART)帮助下受孕的妇女的母婴结局。
方法:PubMed,Embase,WebofScience,我们在Scopus数据库中搜索了观察性研究,这些研究专门针对通过ART实现妊娠的女性,并调查了妊娠早期(妊娠12周内)SCH与母婴结局之间的关系.仅包括单胎妊娠的研究和比较组(无SCH的女性)的报告数据。感兴趣的主要结局包括早期(妊娠20周内)妊娠丢失的发生率,早产,剖腹产,和活产率。汇总效应大小以比值比(OR)和95%置信区间(CI)报告。
结果:纳入9项研究。所有研究都有队列设计。在所有研究中,使用的主要辅助生殖技术是体外受精(IVF).与没有SCH的怀孕相比,诊断为早孕SCH的女性有类似的早产风险(<37周)(OR1.01,95%CI0.83,1.22),低出生体重(<2500g)(OR1.01,95%CI0.59,1.73)和胎儿生长受限(OR1.57,95%CI0.62,4.02)。两组的孕龄(周)(加权平均差(WMD)-0.06,95%CI-0.18,0.06)和出生体重(克)(WMD-16.5,95%CI-62.9,29.8)也相似。早期妊娠丢失的几率(OR1.39,95%CI0.97,2.01),两组的活产(OR0.77,95%CI0.55,1.08)和剖宫产(OR0.97,95%CI0.81,1.16)在统计学上相似.孕产妇不良结局的风险,如妊娠期糖尿病(OR0.98,95%CI0.74,1.29),高血压疾病(OR0.95,95%CI0.63,1.43),两组的胎膜早破(PROM)(OR1.36,95%CI0.90,2.05)和胎盘早剥(OR2.44,95%CI0.57,10.5)也相似.没有发表偏倚的证据。
结论:研究结果表明,在通过ART受孕的妊娠中,SCH可能不会显着增加不良母婴结局的风险。尤其是IVF。
背景:PROSPERO注册号CRD42024533996。
OBJECTIVE: To evaluate the association between first trimester (≤ 12 weeks gestation) subchorionic hemorrhage (SCH), and maternal and neonatal outcomes in women who conceived with the help of assisted reproductive technique (ART).
METHODS: PubMed, Embase, Web of Science, and Scopus databases were searched for observational studies that specifically focused on women who achieved pregnancy via ART and investigated the relationship between early pregnancy (within 12 weeks of gestation) SCH and maternal and neonatal outcomes. Only studies with singleton pregnancies and reporting data on the comparator group (women without SCH) were included. Primary outcomes of interest included incidences of early (within 20 weeks of gestation) pregnancy loss, preterm delivery, caesarean section, and live birth rates. Pooled effect sizes were reported as odds ratio (OR) with 95% confidence intervals (CI).
RESULTS: Nine studies were included. All studies had a cohort design. In all studies, the primary assisted reproduction technique used was in-vitro fertilization (IVF). Compared to pregnancies without SCH, women with diagnosed early pregnancy SCH have a similar risk of preterm birth (< 37 weeks) (OR 1.01, 95% CI 0.83, 1.22), low birth weight (< 2500 g) (OR 1.01, 95% CI 0.59, 1.73) and fetal growth restriction (OR 1.57, 95% CI 0.62, 4.02). The gestational age (in weeks) (weighted mean difference (WMD) - 0.06, 95% CI - 0.18, 0.06) and the birth weight (in grams) (WMD - 16.5, 95% CI - 62.9, 29.8) were also similar in the two groups. The odds of early pregnancy loss (OR 1.39, 95% CI 0.97, 2.01), live birth (OR 0.77, 95% CI 0.55, 1.08) and caesarean delivery (OR 0.97, 95% CI 0.81, 1.16) were statistically similar in both groups. The risk of maternal adverse outcomes such as gestational diabetes (OR 0.98, 95% CI 0.74, 1.29), hypertensive disorder (OR 0.95, 95% CI 0.63, 1.43), premature rupture of membranes (PROM) (OR 1.36, 95% CI 0.90, 2.05) and placental abruption (OR 2.44, 95% CI 0.57, 10.5) was also similar in both the groups. There was no evidence of publication bias.
CONCLUSIONS: The findings suggest that SCH may not significantly increase the risk of adverse maternal and perinatal outcomes in pregnancies conceived through ART, particularly IVF.
BACKGROUND: PROSPERO registration number CRD42024533996.