Analysis of maternal and neonatal outcomes for the living singleton of surgically and spontaneously reduced dichorionic pregnancies following assisted reproductive technology
10.3760/cma.j.cn101441-20230210-00045
- VernacularTitle:辅助生殖技术受孕双绒毛膜双胎手术减胎与自然减胎活产儿母婴结局分析
- Author:
Yuqing FU
1
;
Leizhen XIA
1
;
Yan ZHAO
1
;
Yina HU
1
;
Jinxia HE
1
;
Ling NIE
1
Author Information
1. 江西省妇幼保健院生殖医学中心，南昌 330000
- Publication Type:Journal Article
- Keywords:
Reproductive technology, assisted;
Pregnancy reduction, multifetal;
Surgical reduction;
Spontaneous reduction;
Maternal and neonatal outcome
- From:
Chinese Journal of Reproduction and Contraception
2023;43(12):1249-1254
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the difference of maternal and neonatal outcomes for the living infant of surgically and spontaneously reduced dichorionic pregnancies following assisted reproductive technology (ART).Methods:We used a retrospective cohort study to analyze the clinical data of 11 050 fresh/frozen-thawed double embryos transfer with singleton live birth cycles in the Center for Reproductive Medicine of Jiangxi Maternal and Child Health Hospital from March 2014 to October 2021, including 226 cases in the surgical reduction group, 1 506 cases in the spontaneous reduction group, and 9 318 cases of singleton pregnancy in control group. The basic clinical data, maternal and fetal complications and birth outcomes of the three groups were compared by univariate analysis. Multivariate logistic regression was used to analyze the factors affecting maternal and infant outcomes.Results:The rate of premature rupture of membranes in the natural fetal reduction group, the surgical reduction group and control group was 1.4% (21/1 506), 1.3% (3/226) and 0.6% (56/9 318), respectively, with a significant difference among the three groups ( P=0.003). The differences of the risk of preterm birth, very premature birth, low birth weight, very low birth weight, and small for gestational age among the surgical fetal reduction group [17.3% (39/226), 4.0% (9/226), 15.5% (35/226), 3.1% (7/226), 9.3% (21/226)], the natural fetal reduction group [11.6% (175/1 506), 1.9% (28/1 506), 8.6% (129/1 506), 1.3% (20/1 506), 9.1% (137/1 506)] and control group [7.7% (721/9 318), 0.9% (86/9 318), 3.9% (367/9 318), 0.5% (45/9 318), 6.0% (560/9 318)] were statistically significant (all P<0.001). Compared with the spontaneous reduction group, the surgical reduction group had a higher risk of premature birth [(a OR=2.37, 95% CI: 1.64-3.42, P<0.001) vs. (a OR=1.54, 95% CI: 1.29-1.84, P<0.001)], very preterm birth [(a OR=4.26, 95% CI: 2.02-8.97, P=0.001) vs. (a OR=1.95, 95% CI: 1.26-3.01, P=0.003)], low birth weight [(a OR=4.35, 95% CI: 2.94-6.44, P<0.001) vs. (a OR=2.26, 95% CI: 1.83-2.79, P<0.001)] and small-for-gestational age[(a OR=1.82, 95% CI: 1.14-2.92, P=0.013) vs. (a OR=1.60, 95% CI: 1.31-1.95, P<0.001)]. There was no statistical difference in birth defect rate among the three groups ( P>0.05). Conclusion:The risk of maternal and fetal complications and birth defects for the living singletons of surgically and spontaneously reduced dichorionic diamniotic pregnancies were similar to those singleton pregnancies following ART, but the proportion of premature rupture of membranes is higher, and the risk of premature birth and low birth weight of surgical reduction were higher than that of spontaneous reduction. Surgical reduction is not recommended to use as a rescue measure of dichorionic twins conceived by ART.
