[体外受精与自然受孕双胎妊娠的围产期结局比较]
[Perinatal outcomes of twin pregnancies conceived through in vitro fertilization versus spontaneous].
作者信息
Rubio-Cid Paula, Alvarez-Silvares E, Aves-Pérez María Teresa, García-Lavandeira Sandra, Pérez-Adán Marta
出版信息
Ginecol Obstet Mex. 2015 Oct;83(10):602-13.
OBJECTIVE
Determine maternal and fetal characteristics of in vitro fertilization twin pregnancies in comparison with spontaneous twin pregnancies.
MATERIAL AND METHODS
Retrospective historical cohort study between 2011 and 2013. Statistical analysis was performed with SPSS 15.0 program and Epidat 3.0. A value of p<0.05 was considered statistically significant.
RESULTS
96 twin pregnancies met inclusive criteria with an incidence of 2.01%, of which 54.16% were spontaneous twin pregnancies and 45.83% in vitro fertilization twin pregnancies. Mean maternal age at delivery was higher in vitro fertilization twin pregnancies (p=0.004). The primigravidae were more frequent in vitro fertilization twin pregnancies group (p<0.001). Monochorionic pregnancies percentage was superior in spontaneous pregnancies (p=0.009). Amenorrhea at delivery was not a significant difference between cohorts (p=.9). Preterm rate was superior in spontaneous twin pregnancies group (p=0.003). However, "great preterm deliveries" were higher in in vitro fertilization twin pregnancies (p<0.001). Significant differences were not observed in fetal presentation at delivery, first-born child birth-weight or intrauterine growth retardation between the two groups. Nevertheless, the mean birth-weight of second-born spontaneously conceived twins was higher than second-born twins of the in vitro fertilization conceived group (p=0.027). Gestational pathology presented the same distribution in both cohorts. There was no significant difference in the mode of delivery between the two groups. Total perinatal mortality rate was 20,83%o and comprised 2 first born twins and 2 second born twins. Three of the stillbirths came from the spontaneous pregnancies group and one from the in vitro fertilization group.
CONCLUSIONS
Perinatal death was secondary to stillbirths, which we found higher in spontaneously conceived twin pregnancies due to higher number of monochorionic pregnancies.
目的
比较体外受精双胎妊娠与自然双胎妊娠的母体和胎儿特征。
材料与方法
2011年至2013年的回顾性历史队列研究。使用SPSS 15.0程序和Epidat 3.0进行统计分析。p<0.05的值被认为具有统计学意义。
结果
96例双胎妊娠符合纳入标准，发生率为2.01%，其中54.16%为自然双胎妊娠，45.83%为体外受精双胎妊娠。体外受精双胎妊娠的产妇平均分娩年龄较高（p=0.004）。初产妇在体外受精双胎妊娠组中更为常见（p<0.001）。单绒毛膜妊娠百分比在自然妊娠中更高（p=0.009）。分娩时闭经在队列之间无显著差异（p=0.9）。早产率在自然双胎妊娠组中更高（p=0.003）。然而，“极早早产”在体外受精双胎妊娠中更高（p<0.001）。两组在分娩时的胎儿胎位、头胎出生体重或宫内生长迟缓方面未观察到显著差异。尽管如此，自然受孕双胎的二胎平均出生体重高于体外受精受孕组的二胎（p=0.027）。妊娠病理在两个队列中的分布相同。两组之间的分娩方式无显著差异。围产期总死亡率为20.83‰，包括2名头胎双胎和2名二胎双胎。3例死产来自自然妊娠组，1例来自体外受精组。
结论
围产期死亡继发于死产，我们发现自然受孕双胎妊娠中的死产率更高，原因是单绒毛膜妊娠数量更多。
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