| Objective:The clinical medical records of women with assisted reproductive technology(ART)were analyzed retrospectively,objective to investigate the clinical characteristics and perinatal outcomes of pregnant women with ART.Methods:A total of 2348 pregnant women who applied assisted reproductive technology in Fujian Maternity and Child Health Hospital from January 2013 to December 2018 were selected(1633 cases of the single pregnancy group,715 cases of the twin pregnancy group),and a total of 4696 pregnant women with spontaneous conceptions(3266 cases of the single pregnancy group,1430 cases of the twin pregnancy group)during the same period were randomly selected.The complications of pregnancy(Gestational diabetes mellitus,hypertensive disorders of pregnancy,gestational intrahepatic cholestasis disease and HELLP syndrome)were retrospectively analyzed between the single pregnancy group with ART and the single pregnancy group of natural pregnancy,the twin pregnancy group with ART and the twin pregnancy group of natural pregnancy.And neonatal outcomes(neonatal malformation,neonatal death,transferred to the NICU treatment rate,birth weight,neonatal pneumonia,hypoxie-ischemic encephalopathy,neonatal hyperbilirubinemia,neonatal hypoglycemia,and Apgar score)were retrospectively analyzed between the single pregnancy group with ART and the single pregnancy group of natural pregnancy,the same was done in the twin pregnancy group.According to the delivery mode,they were divided into the single vaginal delivery group with ART and the single vaginal delivery group of natural pregnancy,the single cesarean section delivery group with ART and the single cesarean section delivery group of natural pregnancy,the twin vaginal delivery group with ART and the twin vaginal delivery group of natural pregnancy,the twin cesarean section delivery group with ART and the twin cesarean section delivery group of natural pregnancy.The incidence of premature rupture of membranes,postpartum hemorrhage,premature delivery,uterine curettage,the blood loss of placental expulsion and 2 hours after delivery were compared.Results:1.Comparison of general clinical data(1)The general clinical data: There are 1633 cases of single pregnant women with ART(single vaginal delivery 41.20%,single cesarean section 58.80%),715 cases of twin pregnancy(twin vaginal delivery 11.60%,twin cesarean section 88.40%).There were 3266 cases of single pregnant women of NC(single vaginal delivery 66.50%,single cesarean section 33.50%),1430 cases of twin NC(twin vaginal delivery 25.70%,twin cesarean section 74.30%).(2)Clinical characteristics of pregnant women: There were statistically significant differences in gravida,para,age,gestational age,delivery mode between the single pregnancy group with ART and the single pregnancy group of NC(1633 cases vs 3266cases)(P<0.05).There were statistically significant differences in gravida,para,age,delivery mode between the twin pregnancy group with ART and the twin pregnancy group of NC(715 cases vs 1430 cases)(P<0.05).2.Comparison of pregnancy complications between the two groups:(1)Pregnancy complications were compared in the single pregnancy group with ART with the single pregnancy group of NC(1633 cases vs 3266 cases):The incidence of preeclampsia and GDM during pregnancy were higher in the single pregnancy group with ART than in the single pregnancy group of NC(P<0.05).There was no statistically significant difference in the incidence of estational hypertension,HELLP syndrome,chronic hypertension with superimposed preeclampsia and intrahepatic cholestasis of pregnancy(P> 0.05).(2)Pregnancy complications were compared in the twin pregnancy group with ART with the twin pregnancy group of NC(715 cases vs 1430 cases):The incidence of GDM,gestational hypertension,preeclampsia and intrahepatic cholestasis of pregnancy were higher in the twin pregnancy group with ART than in the twin pregnancy group of NC(P<0.05).There was no statistically significant difference in the incidence of chronic hypertension with superimposed preeclampsia and HELLP syndrome(P>0.05).3.Comparison of complications during childbirth between the two groups:(1)Comparison of intrapartum complications in single vaginal delivery group with ART with single vaginal delivery group of NC(673 cases vs 2171 cases): The incidence of PROM,PPH,the blood loss of placental expulsion and 2 hours after delivery were significantly higher in the single vaginal delivery group with ART than in the single vaginal delivery group of NC(P<0.05).There was no significant difference in the incidence of premature delivery and curettage and the duration of the third stage of labor between the two groups(P>0.05).(2)Compared with the intrapartum complications in the single cesarean section delivery group with ART with the single cesarean section delivery group of NC(960cases vs 1095cases):The blood loss of 2 hours after delivery in the single cesarean section delivery group with ART was higher than that in the single cesarean section delivery group of NC(P<0.05).There was no significant difference in the incidence of PROM,premature delivery and PPH(P> 0.05).(3)Comparison of intrapartum complications in the twin vaginal delivery group with ART with the twin vaginal delivery group of NC(83 cases vs 368 cases): The incidence of PROM,premature delivery,the blood loss of placental expulsion,2 hours after delivery and the duration of the third stage of labor were significantly higher in the twin vaginal delivery group with ART than in the twin vaginal delivery group of NC(P<0.05).There was no significant difference in the incidence of PPH and curettage(P<0.05).(4)Compared with the intrapartum complications in the twin cesarean section delivery group with ART with the twin cesarean section delivery group of NC(632 cases vs 1062 cases):The incidence of PPH blood and loss of 2 hours after delivery in the twin cesarean section delivery group with ART was higher than that in the twin cesarean section delivery group of NC(P<0.05).There was no significant difference in the incidence of PROM,premature delivery(P>0.05).4.Comparing the neonatal outcomes between the two groups:(1)Neonatal outcomes were compared in the single pregnancy group with ART with the single pregnancy group of NC(1633 cases vs 3266 cases): The rates of treatment transferred to neonatology department and observation room for high-risk infants and neonatal pneumonia of the single pregnancy group with ART were higher than those in the single pregnancy group of NC(P<0.05).There were no significant differences in the incidence of neonatal malformation,neonatal weight,hypoxie-ischemic encephalopathy,neonatal hyperbilirubinemia,neonatal hypoglycemia,Apgar score and neonatal death between the single pregnancy group with ART and the single pregnancy group of NC(P>0.05).(2)Comparison of neonatal outcomes in the twin pregnancy group with ART with the twin pregnancy group of NC(1430 cases vs 2860 cases): The rates of treatment transferred to observation room for high-risk infants of the twin pregnancy group with ART were higher than that in the twin pregnancy group of NC(P<0.05).The incidence of neonatal death and neonatal hyperbilirubinemia was lower than that in the twin pregnancy group of NC,(P<0.05).There were no significant differences in the rates of treatment transferred to neonatology department,neonatal malformation,hypoxie-ischemic encephalopathy,neonatal hypoglycemia,neonatal weight and Apgar score between the twin pregnancy group with ART and the twin pregnancy group of NC(P>0.05).5.Comparison of pregnancy complications between the single pregnancy group with ART and the twin pregnancy group with ART(1)Comparison of the general clinical data between the single pregnancy group with ART and the twin pregnancy group with ART: There were statistically significant differences in gestational age,age,delivery mode between the single pregnancy group with ART and the twin pregnancy group with ART(P<0.05).There was no statistically significant difference in the gravida and para(P>0.05).(2)Comparison of pregnancy complications between the two groups: The incidence of preeclampsia and ICP were higher in the twin pregnancy group with ART than in the single pregnancy group with ART(P<0.05).There was no statistically significant difference in the incidence of GDM,HELLP syndrome and chronic hypertension and chronic hypertension with superimposed preeclampsia(P>0.05).(3)Comparison of complications during childbirth between the two groups: The incidence of premature delivery,the blood loss of placental expulsion,2 hours after delivery and curettage were significantly higher in the twin pregnancy group with ART than in the single pregnancy group with ART(P<0.05).The incidence of PPH was higher in the twin pregnancy group with ART than in the single pregnancy group with ART,and the difference was not statistically significant(P>0.05).Conclusions:1.Compared with natural pregnancy,The proportion of elderly primiparas in ART pregnancy increased,and the incidence of twin pregnancy and cesarean section increased.2.In twin pregnancy,compared with natural pregnancy,the incidence of gestational hypertension,preeclampsia,GDM and ICP is significantly increased in the twin pregnancy with ART.3.Compared with natural pregnancies,the incidence of perinatal complications in ART pregnancies is increased significantly.The risk of GDM was significantly increased in the single pregnancy with ART,which may be related to the increase of maternal age.The risk of GDM,HDP and PPH significantly increased in the twin pregnancy with ART,which may be related to an increased incidence of twin pregnancies.Therefore,the increased risk of ART pregnancy is partly caused by the increased age and the significant increase in the incidence of twin pregnancy.Multiple pregnancy has become a negative factor affecting the pregnancy outcomes of ART pregnancy.ART pregnancy should pay more attention to how to ensure a stable pregnancy rate while effectively reducing multiple pregnancies and the outcomes it brings,strengthen the management of pregnancy,and actively prevent the occurrence of perinatal complications.4.Compared the neonatal outcomes with natural pregnancies,There was no significant difference in the incidence of birth weight and neonatal malformation between the two groups,indicating that ART does not increase adverse neonatal outcomes. |
PDF Full Text Request