(P<0.05) ( ) (P<0.05) (P>0.05) [DOI] /j.issn

Med J Chin PLA, Vol. 42, No. 11, November 1, 2017 1001 811 [ ] ( ) 2015 1 1 2016 12 31 811 ( )518 ( )293 (P<0.05) (P<0.05) (P<0.05) ( )(P<0.05) (P>0.05) (P>0.05) [ ] [ ] R714.23 [ ] A [ ] 0577-7402(2017)11-1001-05 [DOI] 10.11855/j.issn.0577-7402.2017.11.12 Perinatal complications and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques and those conceived spontaneously: A retrospective analysis of 811 cases YU Jin, GUO Yu-na *, XIE Xian-jing The International Peace Maternity and Child Health Hospital of China Welfare Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China * Corresponding author, E-mail: gyuna@live.com [Abstract] Objective To investigate the general situations of gravida, pregnancy complications, childbirth and neonatal outcomes of twin pregnancies conceived by assisted reproductive techniques (ART) and those conceived spontaneously. Methods A retrospective analysis was carried out on the basic information, perinatal complications, delivery information and neonatal outcomes of twin pregnancies received by ART (ART group, n=518) and those conceived spontaneously (SC group, n=293). Results Gravida age was older in ART group than in SC group (P<0.05), while the gravidity and parity in ART group was more than that in SC group (P<0.05). There were more embryos and high proportion of diamniotic cyst in ART group than in SC group (P<0.05). The gestational incidence of diabetes, abnormal placenta (placental adherence, placenta accrete, placenta previa) and postpartum hemorrhage were higher in ART group than in SC group (P<0.05), while no statistically significant differences existed between the two groups in the incidence of gestational complications (such as gestational hypertension disease, cholestasis and amniotic fluid volume abnormality) and in neonatal outcomes including neonatal weight, incidence of asphyxia and congenital malformation and neonatal death (P>0.05). Conclusion Twin pregnancy conceived by ART may lead to higher incidences of gestational diabetes mellitus and abnormal placenta and more postpartum hemorrhage, but no significant difference existed in the neonatal outcomes between twin pregnancies conceived by ART and those conceived spontaneously. [Key words] twin pregnancy; assisted reproductive techniques; pregnancy complications; pregnancy outcome [ ] [ ] 200030 ( ) [ ] E-mail gyuna@live.com

1002 2017 11 1 42 11 ( ) [1-8] 1 1.1 2015 1 1 2016 12 31 31 823 (>28 ) 811 ( 2.6%) ( n=518) (n=293) (PGD) 1.2 Apgar B B 8 [9] (5min Apgar <7 ) 7 [10] 1.3 SPSS 17.0 x±s t χ 2 P<0.05 2 2.1 811 518 293 (63.9%) (36.1%) (32.7 3.5 ) (30.0 3.7 P<0.05) 35 (P<0.05) (P<0.05) (P<0.05) (P>0.05 1) 1 Tab.1 Comparison of general situation and delivery modes between the two twin pregnancy groups Item ART group (n=518) SC group (n=293) Age (year) 32.7 3.5 30.0 3.7 2.061 0.000 35 years [n(%)] 146(28.2) 36(12.3) 5.104 0.000 Gravidity and parity Gravidity 1.72 1.00 2.05 1.15 3.105 0.000 Parity 1.05 0.24 1.29 0.56 4.141 0.040 Number of fertilized eggs [n(%)] 1 13(2.5) 101(34.5) 3.147 0.000 2 505(97.5) 192(65.3) Chorion prosperity [n(%)] Monochorionic 35(6.8) 100(34.1) 2.720 0.000 Dichorionic 483(93.2) 193(65.9) Delivery mode [n(%)] Cesarean section 515(99.4) 291(99.3) 1.672 0.873 Vaginal delivery 3(0.6) 2(0.7) Operation time [n(%)] Selective operation 437(84.3) 232(79.2) 0.700 0.543 Emergency operation 81(15.7) 61(20.8) Gestational weeks of delivery 35.1 2.3 35.6 2.4 0.120 0.900 ART. Assisted reproductive techniques; SC. Conceived spontaneously 2.2 (P<0.05) / (P<0.05) ( OR 1.91 95%CI 0.93~3.93) 1.91 ( OR 1.57 95%CI 0.93~2.63) 1.57 ( OR 2.17 95%CI 1.56~3.00) 2.17 / (P<0.05 2) χ 2 /t P

Med J Chin PLA, Vol. 42, No. 11, November 1, 2017 1003 2 Tab.2 Comparison of gestational complications between the two twin pregnancy groups Item ART group (n=518) SC group (n=293) χ 2 /t P Adjusted OR 95% CI Placenta abnormalities [n(%)] 63(12.2) 17(5.8) 8.514 0.004 1.91 0.93-3.93 Placenta previa 16(3.1) 5(1.7) 1.418 0.034 Placenta abruption 2(0.4) 2(0.7) 0.335 0.563 Placenta accrete 7(1.4) 0 3.994 0.046 Placenta adhesion 26(5.0) 6(2.0) 4.360 0.037 Racket/Velum placenta 12(2.3) 4(1.4) 1.835 0.247 Gestational diabetes mellitus [n(%)] 104(20.1) 39(13.3) 5.900 0.015 2.17 1.56-3.00 Hypertensive disorder complicating pregnancy [n(%)] 97(18.7) 44(15.0) 1.291 0.256 Gestational hypertension 35(6.8) 14(4.8) 0.357 0.489 Pre-eclampsia 58(11.2) 28(9.6) 0.126 0.900 Eclampsia 0 0 HELLP 4(0.8) 2(0.7) 3.580 0.675 Intrahepatic cholestasis of pregnancy [n(%)] 22(4.2) 8(2.7) 0.531 0.466 Twin transfusion syndrome [n(%)] 1(0.2) 3(1.0) 3.793 0.732 Premature rupture of membranes [n(%)] 60(11.6) 35(11.9) 2.890 0.928 1.57 0.93-2.63 Postpartum hemorrhage volume (ml) 308.5 10.0 273.6 15.3 1.816 0.009 ART. Assisted reproductive techniques; HELLP. Hemolysis elevated liver enzymes and low platelets syndrome; SC. Conceived spontaneously;. No data 2.3 (2483.8 418.5g) (2466.8 410.1g) (P>0.05) (P>0.05 3) 3 Tab.3 Comparison of neonatal outcomes between the two twin pregnancy groups Item ART group (n=1036) SC group (n=586) χ 2 /t P Average weight of newborn (g) 2483.8 418.5 2466.8 410.1 1.158 0.234 Low birth weight (<2500g) infants [n(%)] 471(45.5) 273(46.6) 1.1.78 0.524 Neonatal asphyxia [n(%)] 4(0.4) 2(0.3) 2.376 0.459 Neonatal death [n(%)] 1(0.1) 1(0.2) 0.991 0.625 Neonatal malformation [n(%)] 6(0.6) 4(0.7) 1.980 0.789 ART. Assisted reproductive techniques; SC. Conceived spontaneously 3 80% [11] - (in vitro fertilization and embryo transfer IVF-ET) 2 1992 2012 26.3% 71.0% [6] [1-8] >35 [3-4] [12] ( ) [1-8]

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