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目的:探讨高原地区体外受精-胚胎移植(1VF-ET)助孕妊娠后双胎自然减为单胎的影响因素以及妊娠结局。方法:分析2011年1月—2013年12月在本院生殖中心行试管婴儿助孕的867个周期,选取双胎妊娠自然减为单胎者为研究组(A组,64例),双胎未发生减胎组为对照组(B组,89例)和初始单胎组(C组,181例)。比较三组间临床相关因素及妊娠结局。结果:三组资料患者一般情况均无统计学差异。A组中孕妇年龄≥35岁的构成比及ET日内膜厚度<0.9cm的构成比均大于B组,差异有统计学意义(P<0.05);A组移植优等胚胎质量的构成比低于B组,差异具有统计学意义(P<0.05);A组早期妊娠流产率低于C组(4.7%vs 14.9%),差异有统计学意义(P<0.05);但A组晚期妊娠流产率高于C组(9.4%vs 2.2%),差异有统计学意义(P<0.05)。A组妊娠期高血压的发生率高于C组(10.9%vs 2.8%),差异有统计学意义(P<0.05)。A组胎膜早破的发生率高于C组(21.9%vs 9.0%),差异有统计学意义(P>0.05)。A组与C组比较,分娩孕周、早产率差异均无统计学意义(P>0.05),但新生儿出生体重明显降低(3.08±0.36)kg vs(3.27±0.40)kg,差异有统计学意义(P<0.05)。结论:高原地区妊娠年龄≥35岁、内膜厚度<0.9cm,移植优质胚胎数目比率低,双胎妊娠发生自然减胎的可能性大,双胎自然减为单胎组孕妇较正常单胎妊娠组发生妊娠期高血压疾病、胎膜早破的风险增加,晚期流产率增加,与平原地区相似,与高原缺氧无关,但双胎自然减胎组新生儿出生体重较单胎妊娠组低,可能是由于早期着床拥挤后导致胎盘发育不良,以致在整个孕期胎儿发育缓慢所致,而非早产或高原缺氧的因素。
Objective: To investigate the influencing factors of twins’ natural reduction to singleton after gestation pregnancy with in vitro fertilization and embryo transfer (1VF-ET) and the outcome of pregnancy. Methods: From January 2011 to December 2013, 867 cycles of in vitro fertilization of IVF in our reproductive center were selected. The study group (64 cases in group A) There were no hypothyroidism group as control group (group B, 89 cases) and initial singleton group (group C, 181 cases). The clinical factors and pregnancy outcomes were compared between the three groups. Results: The three groups of patients in general no significant difference. The constituent ratio of pregnant women ≥35 years old in group A and ET <0.9 cm were greater than those in group B (P <0.05), and the proportions of excellent embryos in group A were lower than those in group B (P <0.05). The abortion rate of early pregnancy in group A was lower than that in group C (4.7% vs 14.9%, P <0.05), but the rate of abortion in late pregnancy in group A was significantly higher than that in group C Higher than that of C group (9.4% vs 2.2%), the difference was statistically significant (P <0.05). The incidence of gestational hypertension in group A was significantly higher than that in group C (10.9% vs 2.8%) (P <0.05). The incidence of premature rupture of membrane in group A was significantly higher than that in group C (21.9% vs 9.0%), the difference was statistically significant (P> 0.05). Compared with group C, there was no significant difference in gestational age and premature birth rate between group A and group C (P> 0.05), but birth weight was significantly decreased (3.08 ± 0.36) kg vs (3.27 ± 0.40) kg in neonates Significance (P <0.05). Conclusions: The pregnancy rate in the plateau region is 35 years or older, the thickness of the intima is less than 0.9cm, and the ratio of high quality embryos transferred is low. In the group with hypertensive disorders of pregnancy, the risk of premature rupture of membranes was increased, and the rate of late abortion increased. Similar to the plains area, it was not related to plateau hypoxia. However, the birth weight of newborns in natural twin abortion group was lower than that of singleton gestation group. Probably due to placental dysplasia caused by early implantation crowding, resulting in the slow development of the fetus throughout the pregnancy, rather than the factors of premature birth or altitude hypoxia.