辅助生殖治疗中多胎妊娠的防治

doi:10.6040/j.issn.1671-7554.0.2019.745

摘要/Abstract

摘要： 随着辅助生殖技术(ART)的开展,多胎妊娠率明显升高。多胎妊娠造成的各种孕期并发症、早产、低出生体质量儿可严重威胁母婴生命健康,使其成为影响ART结局的常见医源性并发症。促排卵治疗及鲜胚、冻胚周期移植多个胚胎是导致多胎妊娠的主要原因。加强医务人员及公众对多胎妊娠母儿危害的教育,尽快修订更加细化的促排卵药物应用及移植胚胎数目等ART法规是防止多胎妊娠的最有效保证,严格合理使用促排卵药物、推行单胚胎移植及多胎妊娠减胎术等均可有效预防多胎妊娠的发生。

关键词: 辅助生殖技术, 多胎妊娠, 防治

Abstract: With the development of assisted reproductive technology(ART), the rate of multiple pregnancy is significantly increased. Multiple pregnancy has become a common iatrogenic complication of ART treatment and posed substantial risks to both mothers and perinatals by various pregnancy complications, premature birth, low birth weight infants. Ovulation induction and multiple embryos transfer in fresh and frozen embryo transfers cycle are the main factors 山东大学学报 (医学版)57卷10期 -赵君利,等.辅助生殖治疗中多胎妊娠的防治 \=-causing multiple pregnancy. Strengthening the education of medical staff and the public on the harm of multiple pregnancy, amending the detailed regulations on the use of ovulation induction drugs and number of embryos transfer are the most effective guarantee to prevent multiple pregnancy. Strict and rational use of ovulation induction drugs, promotion of single embryo transfers and multiple pregnancy reduction can effectively reduce multiple births and related adverse consequences of ART.

Key words: Assisted reproductive technology, Multiple pregnancy, Prevention and treatment

中图分类号:

R711.6

赵君利, 袁莹莹. 辅助生殖治疗中多胎妊娠的防治[J]. 山东大学学报 (医学版), 2019, 57(10): 20-26.

ZHAO Junli, YUAN Yingying. Prevention and treatment of multiple pregnancy in assisted reproductive therapy[J]. Journal of Shandong University (Health Sciences), 2019, 57(10): 20-26.

参考文献

[1] 杨菁, 冯亭亭, 孙伟. 医源性多胎妊娠的思考[J]. 中国性科学, 2016(7): 100-103. YANG Jing, FENG Tingting, SUN Wei. Thinking on iatrogenic multifetal pregnanc[J]. The Chinese Journal of Human Sexuality, 2016(7):100-103.
[2] Tiitinen A. Prevention of multiple pregnancies in infertility treatment[J]. Best Pract Res Clin Obstet Gynaecol, 2012, 26(6): 829-840.
[3] Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2009 assisted reproductive technology success rates: national summary and fertility clinic reports[R]. Atlanta: US. Department of Health and Human Services, 2011.
[4] 孙贻娟, 黄国宁, 孙海翔, 等. 关于胚胎移植数目的中国专家共识[J]. 生殖医学杂志, 2018, 27(10): 940-945. SUN Yijuan, HUANG Guoning, SUN Haixiang, et al. Chinese expert consensus on numbers of embryos transferred[J]. Journal of Reproductive Medicine, 2018, 27(10):940-945.
[5] 江兴, 杨菁. 单胎与多胎妊娠卵巢过度刺激综合征的临床分析[J]. 实用妇产科杂志, 2012, 28(7): 600-603. JIANG Xing,YANG Jing. Clinical analysis of single and multiple fetus pregnancy complicated with ovarian hyperstimulation syndrome[J]. Journal of Practical Obstetrics and Gynecology, 2012, 28(7):600-603.
[6] 徐琳, 孙丽洲, 刘娟, 等. Logistic回归分析重度子痫前期母婴不良结局的风险因素[J]. 南京医科大学学报(自然科学版), 2018, 38(8): 1151-1153. XU Lin, SUN Lizhou, LIU Juan, et al. Logistic regression analysis of risk factors for maternal and infant adverse outcomes in severe preeclampsia[J].Acta Universitatis Medicinalis Nanjing, 2018, 38(8):1151-1153.
[7] 罗桂英, 王春艳, 魏兆莲, 等. 医源性多胎妊娠患者的焦虑抑郁现状及影响因素分析[J].中华疾病控制杂志, 2018, 22(4): 374-379. LUO Guiying, WANG Chunyan, WEI Zhaolian, et al. Analysis on the status and influencing factors of anxiety and depression in Iatrogenic multiple pregnancy women[J]. Chinese Journal of Disease Control and Prevention, 2018, 22(4):374-379.
[8] Sibai BM, Hauth J, Caritis S, et al. Hypertensive disorders in twin versus singleton gestations. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units[J]. Am J Obstet Gynecol, 2000, 182(4): 938-942.
[9] European IVF-monitoring Consortium(EIM); European Society of Human Reproduction and Embryology(ESHRE), Calhaz-Jorge C, et al. Assisted reproductive technology in Europe, 2013: results generated from European registers by ESHRE[R]. Hum Reprod, 2017, 32(10): 1957- 1973.
[10] Pinborg A.IVF/ICSI twin pregnancies:risks and prevention[J].Hum Reprod update, 2005, 11(6): 575-593.
[11] Pharoah PO. Risk of cerebral palsy in multiple pregnancies[J]. Clin Perinatol, 2006, 33(2):301-313.
[12] Yokoyama Y, Shimizu T, Hayakawa K. Prevalence of cerebral palsy in twins, triplets and quadruplets[J]. Int J Epidemiol, 1995, 24(5):943-948.
[13] 胡琳莉, 朱桂金. 超促排卵的并发症及相关问题[J]. 中国实用妇科与产科杂志, 2006, 22(5): 391-394. HU Linli, ZHU Guijin. Complications of superovulation and related problems[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2006, 22(5):391-394.
[14] 邵小光, 史艳彬, 张洁. 辅助生殖技术中的双胎妊娠及其应对策略[J]. 中国实用妇科与产科杂志, 2010, 26(10): 765-768. SHAO Xiaoguang, SHI Yanbin, ZHANG Jie.Coping strategies in twin pregnancy of assisted reproductive technology[J].Chinese Journal of Practical Gynecology and Obstetrics, 2010, 26(10):765-768.
[15] 林若芸, 张波, 冯贵雪. 辅助生殖技术中单胚胎移植的伦理考量[J]. 医学与哲学(A), 2016, 37(10): 29-31,40. LIN Ruoyun, ZHANG Bo, FENG Guixue. Ethical reflections on single embryo transfer in assisted reproductive technology[J]. Medicine and Philosophy, 2016, 37(10):29-31,40.
[16] Sunderam S, Boulet SL, Jamieson DJ, et al. Effects of patient education on desire for twins and use of elective single embryo transfer procedures during ART treatment: a systematic review[J]. Reprod Biomed Soc Online, 2018, 6:102-119. doi: 10.1016/j.rbms.2018.10.017.
[17] 孟庆霞, 吴惠华, 李建芬, 等. 选择性减胎可以明显改善多胎妊娠的临床妊娠结局[J].生殖医学杂志, 2017, 26(10): 1035-1040. MENG Qingxia, WU Huihua, LI Jianfen, et al. Multifetal pregnancy reduction improves clinical pregnancy outcome of multiple pregnancies[J]. Journal of Reproductive Medicine, 2017, 26(10):1035-1040.
[18] 乔杰, 马彩虹, 刘嘉茵, 等. 辅助生殖促排卵药物治疗专家共识[J]. 生殖与避孕, 2015, 35(4): 211-223. QIAO Jie, MA Caihong, LIU Jiayin, et al. A consensus of poor ovarian response[J]. Reproduction and Contraception, 2015, 35(4): 211-223.
[19] 王健, 赵君利. 促排卵药物的合理应用[J].中国医院药学杂志, 2008, 28(14): 1205-1208.
[20] 刘寒艳, 刘见桥, 李莉, 等. 年龄及移植胚胎数目对妊娠结局的影响[J]. 广东医学, 2013, 34(2): 247-249.
[21] 刘丰, 刁飞扬, 凌秀凤, 等. 辅助生殖多胎妊娠的影响因素研究[J]. 南京医科大学学报(自然科学版), 2019, 39(5): 762-768. LIU Feng, DIAO Feiyang, LING Xiufeng, et al. Study on the influencing factors of multiple pregnancies after assisted reproduction technology[J]. Acta Universitatis Medicinalis Nanjing(Natural Science),2019,39(5):762-768.
[22] 吴红萍, 陈立雪, 刘平, 等. 控制移植胚胎数目策略在降低北京市体外受精-胚胎移植多胎妊娠率中的应用及效果分析[J]. 中华生殖与避孕杂志, 2018, 38(8): 621-624. WU Hongping, CHEN Lixue, LIU Ping, et al.Application and effect analysis on reducing multiple pregnancy rate of in vitro fertilization-embryo transfer in Beijing[J].Chinese Journal of Reproduction and Contraception, 2018, 38(8): 621-624.
[23] 王致辉, 腊晓琳, 赵静, 等. 选择性单个卵裂期胚胎移植可行性的Meta分析[J].中国循证医学杂志, 2013, 13(10): 1251-1257. WANG Zhihui, LA Xiaolin, ZHAO Jing, et al.Feasibility of elective single cleavage-stage embryo transfer:a Meta-analysis[J]. Chinese Journal of Evidence-based Medicine, 2013, 13(10):1251-1257.
[24] Thurin A, Hausken J, Hillensjö T, et al. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization[J]. N Engl J Med, 2004, 351(23): 2392-2402.
[25] Mersereau J, Stanhiser J, Coddington C, et al. Patient and cycle characteristics predicting high pregnancy rates with single-embryo transfer: an analysis of the Society for Assisted Reproductive Technology outcomes between 2004 and 2013[J]. Fertil Steril, 2017, 108(5): 750-756.
[26] Lee AM, Connell MT, Csokmay JM, et al. Elective single embryo transfer-the power of one[J]. Contracept Reprod Med, 2016, 1: 11. doi: 10.1186/s40834-016-0023-4.
[27] Dyer S, Chambers GM, de Mouzon J, et al. International Committee for Mornitoring Assited Reproductive Technologies world report: assisted reproductive technology 2008,2009 and 2010[J]. Hum Reprod, 2016, 31(7): 1588-1609.
[28] Styer AK, Wright DL, Wolkovich AM, et al. Single-blastocyst transfer decreases twin gestation without affecting pregnancy outcome[J]. Fertil Steril, 2008, 89(6): 1702-1708.
[29] 金海霞, 孙莹璞. 囊胚移植从双胚胎移植到单胚胎移植的经验体会[J]. 生殖医学杂志, 2012, 21(2): 125-128. JIN Haixia, SUN Yingpu. Experience in blastocyst transfer: from double embryo transfer to single embryo transfer[J]. Journal of Reproductive Medicine, 2012, 21(2):125-128.
[30] 马翔, 丁卫, 冒韵东, 等. 授精第3日单胚胎移植与双胚胎移植临床结局分析[J].生殖与避孕, 2011, 31(8): 554-561. MA Xiang, DING Wei, MAO Yundong, et al. Analysis of the clinical result of single embryo transfer and double embryo transfer on day 3[J]. Reproduction and Contraception, 2011, 31(8): 554-561.
[31] 林锦丽, 张林昊. 卵巢低反应患者单胚或双胚胎移植对辅助生殖结局的影响[J]. 生殖医学杂志, 2018, 27(8): 757-760. LIN Jinli, ZHANG Linhao. Effect of single or double embryos transfer on outcomes of assisted reproduction for patients with poor ovarian response[J]. Journal of Reproductive Medicine, 2018, 27(8):757-760.
[32] Chen ZJ, Shi Y, Sun Y, et al. Fresh versus frozen embryos for infertility in the polycystic ovary syndrome[J]. New England Journal of Medicine, 2016, 375(6): 523-533.
[33] Wei D, Liu J, Sun Y, et al. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial[J]. Lancet, 2019, 393(10178): 1310-1318.
[34] Freeman MR, Hinds MS, Howard KG, et al. Guidance for elective single-embryo transfer should be applied to frozen embryo transfer cycles[J]. J Assist Reprod Genet, 2019, 36(5): 939-946.
[35] Practice Committee of American Society for Reproductive Medicine, Practice Committee of Society for Assisted Reproductive Technology. Criteria for number of embryos to transfer: a committee opinion[J]. Fertil Steril, 2013, 99(1):44-46.
[36] Mehta VP, Patel JA, Gupta RH, et al.One plus one is better than two: cumulative reproductive outcomes are better after two elective single blastocyst embryo transfers compared to one double blastocyst embryo transfer[J]. J Hum Reprod Sci, 2018, 11(2): 161-168.
[37] 赵霞. 123例多胎妊娠行选择性减胎患者妊娠结局临床因素分析[D]. 武汉: 华中科技大学, 2011.
[38] Obi(ˇovera)an S, Brock C, Berkowitz R, et al. Multifetal pregnancy reduction[J]. Clin Obstet Gynecol, 2015, 58(3): 574-584.
[39] 马淳, 师娟子, 李明昭, 等. 辅助生殖技术助孕后的多胎妊娠早孕期减胎 91例分析[J]. 生殖与避孕, 2016, 36(9): 774-777. MA Chun, SHI Juanzi, LI Mingzhao, et al. Analysis of transvaginal ultrasound-guided multifetal pregnancy reduction in 91 cases after assisted reproduction[J]. Reproduction and Contraception, 2016, 36(9):774-777.
[40] 焦敏洁. 辅助生殖技术后多胎妊娠结局分析[D].天津:天津医科大学, 2016.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed