Pregnancy after ovarian hyperstimulation syndrome 卵巢过度刺患者的妊娠结果

分类:医学文献 22 0

High pregnancy rates, ranging between 34% and 88%, have been reported in women with ovarian hyperstimulation syndrome (OHSS). In 1967, Rabau et al. were among the first to report a 42% pregnancy rate in patients with OHSS (1), which was confirmed subsequently by most authors who found higher pregnancy rates in in vitro fertilization (IVF) patients in whom OHSS developed compared to IVF patients that did not develop OHSS (2). The largest difference for pregnancy rates between OHSS patients and non-OHSS patients is 73% versus 14%. (3). The authors concluded that the severity of OHSS is related to the probability of conception and with a higher rate of multiple gestation pregnancy (MGP).

研究发现卵巢过度刺激综合征患者(OHSS)的妊娠率很高,为34%-88%。Rabau等人较早研究了OHSS患者的妊娠率情况,他们在1967年报道了OHSS患者妊娠率为42%(1),随后有更多研究人员证实了这个结果,而且他们发现与非OHSS的试管患者相比,OHSS患者的妊娠率更高(2)。OHSS患者和非OHSS患者的妊娠率最大差异为73%对14%(3)。作者得出的结论是,OHSS的严重程度与受孕概率和多胎妊娠率相关。

Mathur and Jenkins (4) debated whether OHSS was associated with a poor obstetric outcome and reviewed forty-one IVF pregnancies complicated by moderate or severe OHSS over a three-year period. They observed no difference in the miscarriage rates between the pregnant OHSS patients and the group of 501 contemporary clinical pregnant patients resulting from IVF procedures without OHSS. They suggest that the higher miscarriage rate other studies report might be attributed to a higher incidence of multiple gestation pregnancy or greater severity of OHSS.

Mathur和Jenkins(4)探讨了OHSS是否与不良产科结果相关的问题,并回顾了3年期间41例中度或重度OHSS的试管妊娠结果。他们发现OHSS患者怀孕组与同时期501名临床试管怀孕非OHSS患者组之间的流产率没有差异。因此,他们认为其他研究发现的较高流产率可能归因于较高的多胎妊娠发生率或更严重的OHSS并发症。

The risk of miscarriage is apparently higher in patients with severe OHSS than in IVF patients without OHSS. Most authors have found miscarriage rates in women with OHSS ranging between 27% and 40% (5), with only a few authors finding no difference (6). These high miscarriage rates are thought to have been caused by the excessively high serum estradiol levels, high cytokine production, and excessive rennin-angiotensin activity, which are all characteristic of OHSS.

OHSS严重患者的流产风险明显高于非OHSS患者。大多数研究人员发现OHSS患者的流产率在27%到40%之间(5),只有少数人员发现两者间没有差异(6)。这么高的流产率被认为是由于OHSS综合征带来的过高的血清雌二醇水平、高细胞因子产生和肾素-血管紧张素活性导致的。

One of the largest studies on pregnancy outcome after OHSS is that of Abramov et al. (7), who reviewed all patients hospitalized between 1987 and 1996 in a multicenter study in Israel. Overall they found higher pregnancy rates, miscarriages, multiple gestation pregnancies, gestational diabetes, placental abruption, preterm birth and low birth weight in IVF patients with OHSS compared with IVF patients without OHSS. A high number (2902) of their patients were hospitalized for OHSS management and of these patients, 209 were severe or critical and 163 were IVF patients. Most were young (mean age: 29 years) and healthy women with a mean of 4.4 years of infertility duration. The clinical pregnancy rate was 73% including 42% singletons, 34% twins, 17% triplets, and 7% quadruplets. The pregnancy loss rate was 30%, of which 25% were early pregnancy losses and 4.8% were late miscarriages. Fetal reduction was performed in 25% of multiple gestation pregnancies in addition to the occurrence of spontaneous reduction or vanishing twins in 18%, with threatened miscarriage in 18%. Premature rupture of membranes occurred in 18% of patients compared with 5% occurrence in other IVF patients. Pregnancy-induced hypertension occurred in 13% of OHSS patients compared with 6% in the general IVF population, and gestational diabetes occurred in 6% versus 0.8%. The mean gestational age was 37 weeks for singletons, 35 for twins, and 34 for triplets. Preterm birth occurred in 28% of the singleton pregnancies, 50% of the twin pregnancies, and 100% of triplet pregnancies. The rate of Cesarean section delivery was 44%.

Abramov等人对OHSS患者妊娠后结果进行了一项较大型的研究(7)。他们在以色列对多个医疗中的所有住院患者进行调查,并回顾了从1987年至1996年间的妊娠结果。总而言之,他们发现与非OHSS的试管患者相比,OHSS试管患者的妊娠率、流产率、多胎妊娠率、妊娠糖尿病、胎盘早剥、早产和胎儿低出生体重的发生率更高。有大量(2902名)患者住院治疗OHSS综合征,包括209年重症或危重患者,其中163名是试管患者。大多数患者都很年轻(平均年龄是29岁),身体健康,平均不孕不育时长为4.4年。他们的临床妊娠率为73%,其中单胎,双胎,三胎和四胎妊娠率分别为42%,34%,17%和7%。流产率为30%,其中25%为早期流产,4.8%为晚期流产。在多胎妊娠里,25%患者进行了减胎手术,18%发生自发减胎或双胞胎消失综合征,其中先兆流产发生率为18%。OHSS患者发生胎膜早剥的比例为18%,而其他试管患者的发生率为5%。OHSS患者妊娠高血压发生率为13%,而一般试管人群为6%。OHSS患者和非OHSS患者的妊娠糖尿病发生率分别为6%和0.8%。OHSS患者单胎妊娠的平均孕周为37周,双胎为35周,三胎为34周。单胎,双胎,三胎妊娠的早产率分别为28%,50%和100%。剖腹产率为44%。

References

参考文献

1. Rabau E, David A, Serr DM, Mashiach S, Lunenfeld B. Human menopausal gonadotrophins for anovulation and sterility. Results of 7 years of treatment. Am J Obstet Gynecol 1967; 98: 92-98.

2. Delvigne A, Demoulin A, Smitz J, et al. The ovarian hyperstimulation syndrome in in-vitro fertilization: a Belgian multicentric study. I. Clinical and biological features. Hum Reprod 1993; 8: 1353-1360.

3.Raziel A, Schacter M, Friedler S, Ron-El R. Outcome of IVF pregnancies following severe OHSS. Reprod Biomed Online 2009; 19: 61-65.

4. Mathur RS, Jenkins JM. Is ovarian hyperstimulation syndrome associated with a poor obstetric outcome? Brit J Obstet Gynaecol 2000; 107: 943-946.

5. Chen CD, Wu MY, Chao KH, et al.. Serum estradiol level and oocyte number in predicting severe ovarian hyperstimulation syndrome. J Formos Med Assoc 1997; 96: 829-834.

6. Mathur R, Akande A, Keay SD, Hunt LP, Jenkins JM. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril 2000; 73: 901-907.

7. Abramov Y, Elchalal U, Schenker JG. Obstetric outcome of in-vitro fertilized pregnancies complicated by severe ovarian hyperstimulation syndrome: a multicenter study. Fertil Steril 1998; 70: 1070-1075.

3. The amount of payment in this agreement is 9999 in US dollar. 5000 of this fee is due and payable when this agreement is signed; the balance shall be due and payable on the day when fetal heartbeat is detected.

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