Perinatal and neonatal outcomes in multiple gestations: Assisted reproduction versus spontaneous conception
Perinatal and neonatal outcomes in multiple gestations: Assisted reproduction versus spontaneous conception
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DOI：
10.1016/s0002-9378(98)70125-5
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发表时间：
1998-11-01
影响因子：
9.8
通讯作者：
Fluker, MR
中科院分区：
文献类型：
--
作者：
Fitzsimmons, BP;Bebbington, MW;Fluker, MR
目的：我们的目的是检验辅助生殖治疗导致的多胎妊娠比自发受孕导致的多胎妊娠结局更好的假设。研究设计：这是一项回顾性队列研究。病例来自辅助生殖技术妊娠。对照组来自同一时间段内分娩的自发多胎妊娠。匹配是根据母亲的年龄、产次、胎儿数量和母亲的医疗问题进行的。共研究72例（56对双胞胎和16对三胞胎）和124例对照（108对双胞胎和16对三胞胎）。主要结局是围产期死亡率。次要结局是早产，出生体重，产妇并发症，新生儿发病率和住院时间。结果：与辅助生殖技术产生的双胞胎相比，自然双胎妊娠的围产儿死亡率显著增加（24比2，P = 0.003）。三胞胎的围产儿死亡率无差异。辅助生殖技术产生的双胞胎和三胞胎诊断时的平均孕龄较低（分别为9.4 vs 13.3; P <0.001和8.8 vs 15.8; P <0.001）。辅助生殖技术组三胞胎的环扎率和产前检查次数较高（分别为P = 0.05和0.02）。分娩时的平均胎龄、出生体重、早产率、早产胎膜早破、妊娠高血压和妊娠期糖尿病的发生率在两组之间没有显著差异。新生儿发病率无显着差异detected.CONCLUSIONS：辅助生殖技术相关的双胞胎有较低的围产儿死亡率比自然受孕的双胞胎。围产期和新生儿发病率，分娩时的胎龄和出生体重不受辅助生殖技术的影响，即使在该组中进行更密切的监测和诊断时的胎龄更早。差异可能是由于自发妊娠组单绒毛膜胎盘形成的频率较高。
OBJECTIVE: Our purpose was to test the hypothesis that multiple pregnancies resulting from assisted reproductive therapy have a better outcome than those resulting from spontaneous conception.STUDY DESIGN: This was a retrospective cohort study. Cases came from pregnancies from assisted reproductive techniques. Controls were identified from spontaneous multiple pregnancies delivered in the same time period. Matching was done for maternal age, parity, fetal number, and presence of maternal medical problems. A total of 72 cases (56 twins and 16 triplets) and 124 controls (108 twins and 16 triplets) were studied. The primary outcome was perinatal mortality. Secondary outcomes were preterm delivery, birth weight, maternal complications, neonatal morbidity, and length of hospitalization.RESULTS: Perinatal mortality is significantly increased in spontaneous twin gestations compared with twins resulting from assisted reproductive techniques (24 vs 2, P = .003). No difference is seen in the perinatal mortality in triplets. Mean gestational age at diagnosis was lower for twins and triplets resulting from assisted reproductive techniques (9.4 vs 13.3; P < .001 and 8.8 vs 15.8; P < .001, respectively). Rate of cerclage and number of prenatal visits was higher for triplets in the assisted reproductive techniques group (P = .05 and .02, respectively). Mean gestational age at delivery, birth weight, rate of preterm labor, preterm premature rupture of membranes, pregnancy-induced hypertension, and incidence of gestational diabetes were not significantly different between the groups. No significant differences in neonatal morbidity were detected.CONCLUSIONS: Assisted reproductive techniques-associated twins have lower perinatal mortality than spontaneously conceived twins. Perinatal and neonatal morbidity, gestational age at delivery, and birth weight are not affected by assisted reproductive techniques, even with closer surveillance and earlier gestational age at diagnosis in this group. Differences may be due to a higher frequency of monochorionic placentation in the spontaneously conceived group.