Spontan ve invitro fetilizasyon (IVF) ikiz gebeliklerin obstetrik ve perinatal sonuçlarının karşılaştırılması

Yıl 2022, , 228 - 233, 26.09.2022

Necdet Öncü , Nazlı Korkmaz

https://doi.org/10.47582/jompac.1163541

Öz

Amaç: Spontan ikiz gebelikler ile invitro fertilizasyon (İVF) yöntemi ile gerçekleşen ikiz gebeliklerin perinatal ve obstetrik sonuçlarını karşılaştırmayı ve analiz etmeyi amaçladık.
Gereç ve Yöntem: Ocak 2016-Ocak 2021 tarihleri arasında üçüncü basamak perinatoloji merkezinde İVF yöntemiyle veya spontan şekilde gerçekleşen ikiz gebeler retrospektif olarak çalışmaya dahil edildi. Gebelerin demografik verileri (cinsiyet, yaş, gebelik haftası) ve doğum şekilleri (spontan ve İVF) analiz edildi. Gebelerde görülen erken membran yırtılması (EMR), preterm doğum (PD) ve intrauterin büyüme geriliği (IUBG) sıklıkları kaydedildi. Ayrıca apgar skorları, fetal anomalilerin varlığı, yenidoğan yoğun bakım (YYB) ihtiyacı ve mortalite oranları analiz edildi.
Bulgular: Toplam 261 ikiz gebe çalışmaya dahil edildi. Ortanca yaş 29 (en az 15-en fazla 40 yıl) ve %23,8 ‘i ≥35 yaşındaydı. Spontan ve IVF gebelik oranları, sırasıyla, %75,9 ve %24,1 idi. İkiz gebeliklerde en sık görülen sorunlar sırasıyla EMR (%14,6), PD (%13,4), GHT (%11,5), oligohidramnios (%6,1), GDM (%4,6) ve polihidramnios (%2,3) idi. Ayrıca %13,8’inde IUBG vardı. IVF gebelerin ortanca yaşı, spontan gebelere göre anlamlı derecede daha yüksekti (33,0-28,0) (p<0,001). Preterm doğum olan gebelerde gebelik yaşı, PD olmayanlara göre anlamlı olarak daha yüksek bulundu (p=0,009). IVF yönetiyle gerçekleşen ikiz gebeliklerde EMR ve PD insidansı spontan gebeliklere göre daha yüksekti (sırasıyla p<0.001 ve p<0.001). İkiz bebeklerin postnatal 1-5. dakika Apgar skorları IVF grubunda daha düşüktü (p<0,001).Bebeklerin yarısından fazlasında YYB ihtiyacı mevcuttu ve bu oran IVF grubunda spontan gruba göre anlamlı olarak daha yüksekti (%71,4-%50,5) (p=0,004).
Sonuç: IVF ikiz gebelikleri EMR ve PD açısından riskli gebeliklerdir. Ayrıca, IVF ikizlerinde YYB ihtiyacı spontan ikiz bebeklere göre daha yüksektir.

Anahtar Kelimeler

İkiz gebelik, invitro fertilizasyon, IVF, EMR, ikiz

A comparison of obstetric and perinatal outcomes of spontaneous and in vitro fertilization (IVF) twin pregnancies

Öz

Aim: We aimed to compare and analyze the perinatal and obstetric outcomes of in vitro fertilization (IVF) method and spontaneous twin pregnancies.
Material and Method: Pregnant women who had had IVF and those with spontaneous fertilization in a tertiary perinatology center between January 2016 and January 2021 were retrospectively included in this study. The demographic data of the women (gender, age, gestational week) and fertilization types (spontaneous or IVF) were analyzed. Premature rupture of membranes (PROM), preterm delivery (PD), and intrauterine growth restriction (IUGR) was recorded. Additionally, Apgar scores, the presence of fetal anomalies, the need for neonatal intensive care (NICU) and mortality were analyzed.
Results: Overall, 261 women who were pregnant with twins were included in this study. The median age of the mothers was 29 years (min 15-max 40 years), and 23.8% were ≥35 years. Spontaneous and IVF pregnancies occurred in 75.9% and 24.1%, respectively. The most common problems in the twin pregnancies were PROM (14.6%), PD (13.4%), GHT (11.5%), oligohydramnios (6.1%), GDM (4.6%), and polyhydramnios (2.3%). Also, 13.8% had IUGR. The median age of the women with IVF pregnancies was higher than the spontaneous pregnancies (33.0 vs 28.0 years) (p<0.001). The maternal age was found to be significantly higher in those women with PD compared to those without PD (33.0 vs 28.0 years) (p=0.009). The incidence of PROM and the rate of PD were significantly higher in the IVF pregnancies group compared to the spontaneous pregnancies group (p<0.001 and p<0.001, respectively). The postnatal 1st and 5th minute Apgar scores of the twin babies were significantly lower in the IVF group (p<0.001). Over the half of babies needed NICU and this rate was significantly higher in the IVF group compared to the spontaneous pregnancy group (71.4% vs 50.5%) (p=0.004).
Conclusion: IVF twin pregnancies are risky pregnancies in terms of PROM and PD. Additionally, the need for NICU is higher for IVF twin birth pregnancies than for spontaneous twin pregnancies.

Anahtar Kelimeler

Twin pregnancy, in vitro fertilization, IVF, PROM, twins

Kaynakça

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