摘要
目的 随着社会辅助生殖技术（ART）需求增加，双胎妊娠发生率随之增加，对于羊穿产前诊断，相比自然受孕双胎，ART双胎孕妇更加关注其胎儿丢失风险。本文目的是对比辅助生殖技术（ART）受孕双胎与自然受孕双胎羊膜腔穿刺术后的胎儿丢失率及产科妊娠结局。方法 回顾2021年~2024年惠州市中心人民医院行羊膜腔穿刺术的双胎妊娠病历资料，排除因致死性畸形、严重染色体异常、严重遗传性疾病等后续需减胎的病例及单绒毛膜双胎病例后，最终纳入25例ART双胎和15例自然受孕双胎，对比ART受孕双胎组与自然受孕双胎组的胎儿丢失情况及产科结局。结果 ART组共50个胎儿，总体胎儿丢失3个（6%，含1例孕23周双胎流产、1例孕33周双胎之一宫内死亡）；自然受孕组共30个胎儿，总体胎儿丢失2个（6.7%，为一例穿刺术后5周胎膜早破致难免流产），两组胎儿总体丢失率相似（Fisher确切概率法，P=1.000）；孕24周前胎儿丢失率分别为4%、6.7%，差异亦无统计学意义（Fisher确切概率法，P=0.643）。两组羊穿术后4周内均未出现胎儿丢失病例。孕28~37周前早产率两组分别为76%、47%，差异无统计学意义（Fisher确切概率法，P=0.083）。结论 初步研究显示ART受孕双胎行羊膜腔穿刺术的胎儿丢失风险和早产风险并未显著高于自然受孕双胎，但需多中心大样本验证。
关键词： 双胎妊娠；胎儿丢失；产科结局；羊膜腔穿刺术；辅助生殖技术
Abstract
Objective With the increasing demand for assisted reproductive technology (ART) in society, the incidence of twin pregnancies has also increased. For prenatal diagnosis through amniocentesis, ART twin pregnancies tend to be more concerned about the risk of fetal loss compared to natural conception twin pregnancies The purpose of this study is to compare the fetal loss rate and obstetric pregnancy outcomes after amniocentesis between ART-conceived twin pregnancies and spontaneous twin pregnancies. Methods The case records of twin pregnancies in which amniocentesis was performed at Huizhou Central People’s Hospital between 2021 and 2024 were reviewed. After excluding cases where subsequent reduction of fetuses was necessary due to fatal malformations, severe chromosomal abnormalities, severe genetic diseases, and cases of mono-chorionic twins, a total of 25 ART twins and 15 spontaneously conceived twins were finallu included. Fetal loss and obstetrical outcomes were compared between the ART and spontaneous twin pregnancy groups. Results In the ART group, there were total 50 fetuses, with 3 fetuses lost (6%, including 1 case of twin miscarriage at 23 weeks of gestation and 1 case of intrauterine death of one of the twins at 33 weeks of gestation；in the spontaneous conception group, there were 30 fetuses, with 2 fetuses lost (6.7%, 1case caused by premature rupture of membranes 5 weeks after amniocentesis), The overall fetal loss rate was similar between the two groups (6%vs. 6.7%, Fisher’s exact test, P = 1.000). The fetal loss rates before 24 weeks of gestation in the two groups were 4% and 6.7%, respectively. There was no statistical difference between the two groups (Fisher’s exact test, P = 0.643). No fetal loss occurred within 4 weeks after the procedure in either group. The preterm delivery rate between 28 and 37weeks of gestation in the two groups were76% and 47%, respectively, and showed no significant difference (Fisher’s exact test, P =0.083). Conclusion Preliminary studies suggest that the risk of fetal loss and preterm birth in ART twin pregnancies undergoing amniocentesis are not significantly higher than spontaneously conceived twins, but it needs to be confirmed by large-scale, multicenter studies.
Key words： Twin pregnancy; Fetal loss; Obstetrical outcomes; Amniocentesis; Assisted reproductive technology
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