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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 169 -173. doi: 10.3877/cma.j.issn.2095-3259.2019.03.010

所属专题： 文献；

论著

体外受精-胚胎移植术后单胎妊娠早产相关因素的临床研究
赵西1, 阿丽米热·麦麦提2, 朱梦兰1, 谭剑平1, 刘玉昆1, 张建平1, 陈慧1,†()   
  1. 1. 510120　广州，中山大学孙逸仙纪念医院妇产科
    2. 844000　喀什，新疆喀什地区第一人民医院妇产科
  • 收稿日期:2019-05-27 出版日期:2019-08-18
  • 通信作者: 陈慧
  • 基金资助:
    广东省自然科学基金项目(2018A030313162)

Clinical study on related factors of premature birth of single pregnancy after in vitro fertilization and embryo transfer

Xi Zhao1, Almiramatmat2, Menglan Zhu1, Jianping Tan1, Yukun Liu1, Jianping Zhang1, Hui Chen1,†()   

  1. 1. 510120 Guangzhou, Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital
    2. 844000 Kashgar, Department of Obstetrics and Gynecology, First People′s Hospital, Kashgar, Xinjiang
  • Received:2019-05-27 Published:2019-08-18
  • Corresponding author: Hui Chen
  • About author:
    Corresponding author: Chen Hui, Email:
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引用本文：

赵西, 阿丽米热·麦麦提, 朱梦兰, 谭剑平, 刘玉昆, 张建平, 陈慧. 体外受精-胚胎移植术后单胎妊娠早产相关因素的临床研究[J/OL]. 中华产科急救电子杂志, 2019, 08(03): 169-173.

Xi Zhao, Almiramatmat, Menglan Zhu, Jianping Tan, Yukun Liu, Jianping Zhang, Hui Chen. Clinical study on related factors of premature birth of single pregnancy after in vitro fertilization and embryo transfer[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2019, 08(03): 169-173.

目的

探讨体外受精-胚胎移植术(in vitro fertilization and embryo transfer，IVF-ET)后单胎妊娠孕妇早产的相关因素及新生儿结局。

方法

回顾性分析2013年8月至2015年8月在中山大学孙逸仙纪念医院分娩的250例孕产妇临床资料，其中IVF-ET后单胎妊娠早产组(A组)50例，自然妊娠单胎早产组(B组)100例，IVF-ET后单胎妊娠足月分娩组(C组)100例。记录妊娠期糖尿病、妊娠期高血压、胎膜早破、前置胎盘或低置胎盘发生率，以及新生儿结局等资料，分析IVF-ET术后单胎妊娠早产相关因素。记录和分析孕期因宫颈机能不全行宫颈环扎术操作的情况。

结果

妊娠期并发症、早产儿出生体重和分娩孕周，A组和B组差异无统计学意义。妊娠期高血压(A组14%、C组3%)，胎膜早破(A组42%、C组14%)，前置胎盘或低置胎盘(A组12%、C组2%)，新生儿出生体重[A组(2225±622)g、C组(3231±482)g]、1 min Apgar评分[A组(8.61±1.77)分、C组(9.49±0.94)分]，5 min Apgar评分[A组(9.66±0.94)分、C组(9.93±0.29)分]，A组和C组比较差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示妊娠期高血压、胎膜早破、前置胎盘或低置胎盘、宫颈机能不全与IVF-ET术后单胎妊娠早产相关。孕期因宫颈机能不全，需行宫颈环扎术的患者，A组为22%，B组为9%，C组为4%，A组与B、C组比较差异均有统计学意义(P均<0.05)。

结论

妊娠期高血压、胎膜早破、前置或低置胎盘、宫颈机能不全是IVF-ET术后单胎妊娠早产的高危因素。IVF-ET术后单胎妊娠早产儿与足月儿相比，出生体重、1 min Apgar评分、5 min Apgar评分均较差。

关键词: 生殖技术，辅助, 早产, 妊娠并发症, 宫颈功能不全
Objective

To investigate the related factors of preterm birth and neonatal outcomes in single pregnancy after in vitro fertilization and embryo transfer (IVF-ET).

Method

A retrospective analysis was conducted in 250 pregnant women in the Sun Yat-sen Memorial Hospital from August 2013 to August 2015. The patients were divided into preterm birth of single pregnancy after IVF-ET (group A, 50 cases), preterm birth of single pregnancy after natural pregnancy (group B, 100 cases) and full-term birth of single pregnancy after IVF-ET (group C, 100 cases). By recording the incidence of gestational diabetes mellitus, gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta, as well as neonatal outcome, analyze the factors related to preterm delivery of single pregnancy after IVF-ET.

Results

There were no significant differences in pregnancy complications, birth weight of premature infants and gestational weeks between group A and group B. The incidences of gestational hypertension in group A and group C were (14% and 3%), premature rupture of membranes (42% and 14%), placenta praevia or low-positioned placenta (12% and 2%), birth weight of newborn [(2225±622) g and (3231±482) g], 1 min Apgar score [(8.61±1.77) and (9.49±0.94)], 5 min Apgar score [(9.66±0.94) and (9.93±0.29)], and the differences between the two groups were statistically significant (P<0.05). Logistic regression analysis showed that gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta, cervical incompetence were associated with preterm birth of single pregnancy after IVF-ET. The incidences of cervical cerclage in pregnancies due to cervical incompetence were 22%, 9% and 4% in group A, group B and group C, respectively. There were significant difference between group A and group B, group C (P<0.05), respectively.

Conclusions

Gestational hypertension, premature rupture of membranes, placenta praevia or low-positioned placenta and cervical incompetence are high risk factors for preterm birth of single pregnancy after IVF-ET. The birth weight, Apgar score at 1 min and 5 min were all worse in preterm infants than in full term infants of single pregnancy after IVF-ET.

Key words: Reproductive techniques, assisted, Premature birth, Pregnancy complications, Uterine cervical incompetence
表1 三组单胎早产患者妊娠并发症和合发症的比较 [例(%)]
分组 例数 妊娠期糖尿病 妊娠期高血压 胎膜早破 前置胎盘或低置胎盘 宫颈环扎术
A组 50 15(30) 7(14)b 21(42)c 6(12)d 11(22)ae
B组 100 23(23) 15(15) 49(49) 5(5) 9(9)
C组 100 36(36) 3(3) 14(14) 2(2) 4(4)
表2 IVF-ET术后单胎妊娠早产相关因素的logistic多因素回归分析
相关因素 OR值 95%CI P值
妊娠期糖尿病 0.603 0.247～1.474 >0.05
妊娠期高血压 9.765 2.129～44.776 <0.05
胎膜早破 7.088 2.863～17.549 <0.05
前置胎盘或低置胎盘 13.684 2.335～80.206 <0.05
宫颈机能不全 12.394 3.149～48.774 <0.05
表3 三组单胎早产患者的新生儿结局
分组 例数(例) 出生孕周(周，MoM) 出生体重(g，±s) 1 min Apgar评分(分，±s) 5 min Apgar评分(分，±s)
A组 50 34＋4a 2225±622b 8.61±1.77c 9.66±0.94d
B组 100 35＋3 2273±562 8.98±1.41 9.80±0.70
C组 100 >37 3231±482 9.49±0.94 9.93±0.29
表4 三组患者紧急宫颈环扎术实施孕周、分娩孕周及术后延长孕周情况
分组 例数 环扎术孕周 分娩孕周 延长孕周数
A组 5 17＋4 35＋3 17＋6
? ? 24＋4 26＋3 1＋6
? ? 20＋5 31＋4 10＋6
? ? 25＋3 32＋3 7
? ? 24 26＋5 2＋5
B组 3 25＋5 28＋2 3＋1
? ? 26＋1 35＋1 9＋2
? ? 13＋5 33＋6 20＋1
C组 3 24＋1 足月 －
? ? 27＋1 足月 －
? ? 26＋4 足月 －
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