Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, East, Gothenburg SE-416 85, Sweden.
Hum Reprod. 2013 Jun;28(6):1598-609. doi: 10.1093/humrep/det082. Epub 2013 Mar 27.
What are the obstetric and neonatal outcomes of deliveries after oocyte donation (OD) in women with Turner syndrome (TS)?
Pregnancies among women with TS carry a substantial risk, particularly for hypertensive disorders. Potentially life-threatening complications occurred in 3.3% of pregnancies. The neonatal outcomes were generally reassuring, with similar rates of preterm birth and low birthweight (LBW) as after conventional IVF and better than previously reported in deliveries after OD in women with TS.
OD pregnancies in women with TS are known to be high-risk pregnancies.
STUDY DESIGN, SIZE, DURATION: This retrospective cohort study included 106 women with TS who delivered after OD (n = 122 deliveries, n = 131 newborns) in three Nordic countries (Finland, Denmark, Sweden) between 1992 and 2011.
PARTICIPANTS, SETTING AND METHODS: Women with TS who delivered after OD in three Nordic countries were identified (n = 110). Four women declined to participate or were lost to follow-up, thus 106 women were included in the study. The medical data from fertility clinics, antenatal clinics and the hospitals where the women had been treated and/or delivered were scrutinized.
In this cohort, the karyotype was 45,X in 44% of the women with TS. Ten women (9.4%) had a known cardiac defect before pregnancy. Single embryo transfer was performed in 70.3% of the cases and the multiple birth rate was 7.4%. In total, 35.0% of the pregnancies were associated with a hypertensive disorder including pre-eclampsia in 20.5%. Potentially life-threatening complications occurred in four pregnancies (3.3%), including one woman with aortic dissection, one with mild regurgitation of the tricuspid and mitral valve, one with a mechanical heart valve who developed HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) and one who underwent a post-partum hysterectomy due to severe haemorrhaging. Neonatal outcomes were reassuring, with a preterm birth rate of 8.0% and LBW rate of 8.8% in singletons. Major birth defects were found in 3.8% of the children. The perinatal mortality was 2.3% (3/131), including a set of extremely preterm twins.
LIMITATIONS, REASONS FOR CAUTION: Although this study was performed over a period of almost 20 years in three different countries, with a low drop-out rate and little missing data, much larger series are needed to assess rare events. This study also lacks an appropriate control group.
This study suggests that cardiovascular evaluation before and during pregnancy may contribute to favourable obstetric outcomes in many cases. Maternal outcomes were in agreement with the literature while neonatal outcomes were generally better than previously reported. The outcomes were consistent across the three countries, supporting generalizability to similar populations.
卵母细胞捐赠（OD）后特纳综合征（TS）女性的分娩的产科和新生儿结局如何？
TS 女性的妊娠风险很大，特别是高血压疾病。3.3%的妊娠发生潜在危及生命的并发症。新生儿结局通常令人放心，早产率和低出生体重（LBW）与传统 IVF 后相似，优于之前报道的 TS 女性 OD 后分娩。
TS 女性的 OD 妊娠是高危妊娠。
研究设计、大小、持续时间：本回顾性队列研究纳入了 1992 年至 2011 年期间在北欧三国（芬兰、丹麦、瑞典）进行卵母细胞捐赠后分娩的 106 名 TS 女性（n=122 次分娩，n=131 名新生儿）。
参与者、设置和方法：确定了在北欧三国进行卵母细胞捐赠后分娩的 TS 女性（n=110）。有 4 名女性拒绝参与或失访，因此有 106 名女性纳入研究。仔细审查了生育诊所、产前诊所和治疗/分娩的医院的医疗数据。
在该队列中，44%的 TS 女性的核型为 45，X。10 名女性（9.4%）在妊娠前有已知的心脏缺陷。70.3%的病例进行了单胚胎移植，多胎率为 7.4%。总共有 35.0%的妊娠与高血压疾病相关，包括 20.5%的子痫前期。有 4 例（3.3%）发生潜在危及生命的并发症，包括 1 例主动脉夹层、1 例三尖瓣和二尖瓣轻度反流、1 例患有机械性心脏瓣膜并发生 HELLP 综合征（溶血、肝酶升高、血小板减少）和 1 例因严重出血而进行产后子宫切除术。新生儿结局令人放心，单胎早产率为 8.0%，LBW 率为 8.8%。3.8%的儿童发现主要出生缺陷。围产期死亡率为 2.3%（3/131），包括一对极早产双胞胎。
局限性、谨慎的原因：尽管这项研究在三个不同的国家进行了近 20 年，脱落率低，数据缺失少，但需要更大的系列来评估罕见事件。本研究还缺乏适当的对照组。
这项研究表明，妊娠前和妊娠期间的心血管评估可能有助于改善许多情况下的产科结局。母体结局与文献一致，而新生儿结局通常优于之前的报道。三个国家的结果一致，支持在类似人群中的推广。
