多胎妊娠减胎术对妊娠结局妊娠期并发症及新生儿出生结局的影响

目的探讨多胎妊娠减胎术(MPR)对妊娠结局、妊娠期并发症和新生儿出生结局的影响。方法收集2005年1月至2016年1月在安徽医科大学第一附属医院生殖中心行MPR的孕妇479例为减胎组,选取243例同期怀孕女性为对照组,比较两组孕妇妊娠结局、妊娠期并发症和新生儿出生结局。根据减胎后保留胚胎数,将减胎组分为保留双胎组(n=245)与保留单胎组(n=234)。根据妊娠胚胎数,将对照组分为普通双胎组(n=133)与普通单胎组(n=110),比较4组孕妇妊娠结局、妊娠期并发症和新生儿出生结局。结果减胎组(保留双胎组与保留单胎组)的自然流产率(10.61%和9.83%)均高于普通双胎组(0.75%),保留双胎组的自然流产率高于普通单胎组(3.64%),差异有统计学意义(P<0.05)。保留双胎组与普通双胎组的妊娠期高血压、胎膜早破、早产及新生儿低出生体质量(保留双胎组分别为8.98%、13.47%、41.10%和42.30%,普通双胎组分别为9.02%、11.28%、39.39%和42.80%)的发生率均高于保留单胎组、普通单胎组,新生儿平均出生体质量低于保留单胎组、普通单胎组,差异均有统计学意义(P<0.05)。结论 MPR可能会导致自然流产、自然减胎的风险增加。MPR后保留胎儿数以及正常妊娠胎儿数是影响妊娠期并发症和新生儿出生结局的重要因素。

Effect of multiple pregnancy reduction on pregnancy outcomes,pregnancy complications and neonatal birth outcomes

Objective To explore the effect of multiple pregnancy reduction (MPR) on pregnancy outcomes,pregnancy complicationsand neonatal birth outcomes. Methods From January 2005 to January 2016, 479 pregnant women undergoing MPR were collected as pregnancy reduction group in the Reproductive Medicine Center,the First Affiliated Hospital of Anhui Medical University.At the same time,243 women who obtained clinical pregnancy were collected as control group. The pregnancy outcomes, pregnancy complicationsand neonatal birth outcomes were compared between the two groups. According to the number of embryos retained after MPR, the pregnancy reductiongroup was divided into two sub-groups:retained twin group (n=245) and retained single group (n=234). According to the number of pregnant embryos, the control group was divided into two sub-groups:regular twin group (n=133) and regular single group (n=110). The pregnancy outcomes,pregnancy complications and neonatal birth outcomes were compared.Results The incidence of spontaneous abortion in pregnancy reduction group (the retained twin group was 10.61% and the retained single group was 9.83%) was higher than that in regular twin group (0.75%), the incidence of spontaneous abortion in retained twin group was higher than that in regular single group(3.64%), andthe differenceswere all statistically significant(P < 0.05). The incidence of hypertensive disorder complication pregnancy, preterm premature rupture of the membrane, premature delivery and the low birth weight in retained twin group (8.98%,13.47%, 41.10% and 42.30%,respectively) and regular twin group(9.02%,11.28%,39.39% and 42.80%, respectively) were all higher than those in retained single group and regular single group, the average birth weight of the newborn waslower than that of retained single group and regular single group,andthe differences were all statistically significant(P < 0.05). Conclusions MPR may increase the risk of spontaneous abortion and spontaneous pregnancy loss. The number of retained embryos after MPR or the embryo number of normal pregnancy is an important factor affecting pregnancy complications and neonatal birth outcomes.