产后出血：不仅存在于卵母细胞捐赠妊娠的高血压疾病中。

Postpartum hemorrhage: not only hypertensive disorders in oocyte donation pregnancies.

作者信息

Serena Caterina, Comito Chiara, Simeone Serena, Capannini Eleonora, Tosi Nicola, Ottanelli Serena, Rambaldi Marianna P, Coccia Maria E, Mecacci Federico, Petraglia Felice

机构信息

Division of Obstetrics and Gynecology, Department of Biomedical, Experimental, and Clinical Sciences, Careggi University Hospital, University of Florence, Florence, Italy.

Division of Obstetrics and Gynecology, Department of Biomedical, Experimental, and Clinical Sciences, Careggi University Hospital, University of Florence, Florence, Italy -

出版信息

Minerva Ginecol. 2019 Aug;71(4):281-287. doi: 10.23736/S0026-4784.19.04375-2.

DOI:10.23736/S0026-4784.19.04375-2

PMID:31274261

Abstract

BACKGROUND

The aim of the study is to compare the obstetric outcome between single pregnancies obtained by medically-assisted procreation using oocyte donors (MAP-E) versus homologous gametes (MAP-O) and single spontaneous conception pregnancies (SC).

METHODS

This is a retrospective case-control study on pregnancy outcome of consecutive singleton live birth pregnancies from MAP-E between January 2011 and August 2017 referred to Careggi University Hospital, Florence. The control group includes singleton pregnancies from MAP-O and pregnancies from spontaneous conceptions in the same period. The pregnancy outcomes considered were: postpartum hemorrhage (PPH), cesarean section (CS), gestational diabetes mellitus (GDM), hypertensive disorders including preeclampsia (HDP), preterm birth ≤34 weeks (PTB), and small-for-gestational-age (SGA) fetuses.

RESULTS

The study group included 290 MAP-E pregnancies that were compared with 290 MAP-O and 870 singleton spontaneous conception pregnancies. The three groups did not show significant differences in maternal traits except for mean age (43.4±2.9 vs. 37.7±2.4 vs. 33.6±5.5, P<0.001), including a higher percentage of patients over 45 years (41.3% vs. 5% vs. 0.8%, P<0.001) and higher incidence of obesity (7.2% vs. 1.7%, P=0.02) in MAP-E than in MAP-O. The risk of HDP is increased in singleton pregnancies by oocyte donation with a significantly increased risk if compared to MAP-O (12% vs. 1%, P<0.001, OR=12.6). The risk of PPH in singleton pregnancies from oocyte donation is higher than in MAP-O (22% vs. 9% P<0.0001, OR=2.87). When we considered severe PPH (blood loss >1000 mL) the risk for MAP-E was higher if compared to MAP-O (OR=2.1, P=0.2) and mostly to SC (OR=14, P<0.005). Compared to SC, MAP-E pregnancies showed increased OR for all the outcomes: CS (78% vs. 30.8%, P<0.001, OR=7.91); GDM (26.1% vs. 10.8%, P<0.001, OR=2.92); HDP (12% vs. 2.2%, P<0.001, OR=5.99); PPH (22% vs. 8.5%, P<0.0001, OR=3.0); SGA (16% vs. 11%, P<0.05, OR=1.16); PTB ≤34 weeks (9.4% vs. 1%, P<0.001, OR=7.94).

CONCLUSIONS

Most women who undergo MAP-E are in advanced age, representing a high-risk population for obstetric complications, like HPD and PPH, which stands as the main worldwide cause of maternal mortality.

摘要

背景

本研究旨在比较采用卵母细胞捐赠的医学辅助生殖（MAP-E）单胎妊娠、采用同源配子的医学辅助生殖（MAP-O）单胎妊娠与自然单胎妊娠（SC）的产科结局。

方法

这是一项回顾性病例对照研究，研究对象为2011年1月至2017年8月转诊至佛罗伦萨卡雷吉大学医院的连续单胎活产MAP-E妊娠的妊娠结局。对照组包括同期MAP-O单胎妊娠和自然受孕单胎妊娠。所考虑的妊娠结局包括：产后出血（PPH）、剖宫产（CS）、妊娠期糖尿病（GDM）、包括子痫前期在内的高血压疾病（HDP）、孕周≤34周的早产（PTB）以及小于胎龄（SGA）胎儿。

结果

研究组包括290例MAP-E妊娠，与290例MAP-O妊娠和870例自然单胎妊娠进行比较。除平均年龄外（43.4±2.9岁 vs. 37.7±2.4岁 vs. 33.6±5.5岁，P<0.001），三组产妇特征无显著差异，其中MAP-E组45岁以上患者比例更高（41.3% vs. 5% vs. 0.8%，P<0.001），肥胖发生率也高于MAP-O组（7.2% vs. 1.7%，P=0.02）。卵母细胞捐赠单胎妊娠的HDP风险增加，与MAP-O相比风险显著增加（12% vs. 1%，P<0.001，OR=12.6）。卵母细胞捐赠单胎妊娠的PPH风险高于MAP-O（22% vs. 9%，P<0.0001，OR=2.87）。当考虑严重PPH（失血>1000 mL）时，MAP-E组的风险高于MAP-O（OR=2.1，P=0.2），主要高于自然单胎妊娠组（OR=14，P<0.005）。与自然单胎妊娠相比，MAP-E妊娠所有结局的OR均增加：剖宫产（78% vs. 30.8%，P<0.001，OR=7.91）；妊娠期糖尿病（26.1% vs. 10.8%，P<0.001，OR=2.92）；高血压疾病（12% vs. 2.2%，P<0.001，OR=5.99）；产后出血（22% vs. 8.5%，P<0.0001，OR=3.0）；小于胎龄儿（16% vs. 11%，P<0.05，OR=1.16）；孕周≤34周的早产（9.4% vs. 1%，P<0.001，OR=7.94）。