www.ksmf.org/arhimed   arhimed@ksmf.org   [5/10/2025 2:52:28 PM] http://www.ksmf.org/arhimed/poglej.asp?id=18 Nosecnost in porod dvojckov po postopku IVF-ET Avtor: Sara Korošec, Vinko Boc Mentor: prof.dr. Tomaž Tomazevic, dr.med. Somentor: asist.dr. Tanja Premru-Seršen, dr.med. IZHODIŠCA: Oploditev v epruveti in prenos zarodkov (IVF-ET) sta postala v dvajsetih letih uporabe ucinkovita metoda zdravljenja neplodnosti. Izid postopka sta lahko enoplodna in vecplodna nosecnost. V primerjalni študiji enoplodnih nosecnosti po zunajtelesni IVF-ET niso našli vecjih razlik v poteku in izidu nosecnosti in poroda. Mnogoplodna nosecnost pa predstavlja ze sama po sebi dejavnik tveganja za potek in izid nosecnosti in poroda. Njena pogostnost je pri zunajtelesni oploditvi približno dvajsetkrat vecja kot pri naravni zanositvi, zato predstavlja enega vecjih problemov nosecnosti in poroda po postopku IVF- ET. NAMEN: V naši raziskavi želimo ugotoviti, ali se potek in izid nosecnosti in poroda pri dvojckih spocetih po postopku IVF-ET razlikuje od tistih po spontani zanositvi. METODE: Raziskava je bila retrospektivna. Vanjo smo vkljucili 731 preiskovank z dvoplodnim izidom nosecnosti, ki so rodile dvojcke od aprila 1987 do maja 1995. Našo preiskovano skupino predstavlja 94 mater z dvoplodno nosecnostjo in 188 novorojenckov, spocetih po postopku IVF-ET. Raziskavo smo razdelili na kohortno in kontrolirano študijo. Pri kohortni študiji smo primerjali preiskovano skupino s celotno ljubljansko kohorto 637 mater z dvoplodno nosecnostjo in 1274 novorojenckov po spontani zanositvi. Pri kontrolirani študiji pa smo primerjali preiskovano skupino s 93 materami z dvoplodno nosecnostjo in 186 novorojencki po spontani zanositvi. Pri tej skupini so se matere ujemale s preiskovano skupino po starosti, pariteti in letu poroda. Primerjali smo potek in zaplete nosecnosti, potek, zaplete in izid poroda ter znacilnosti novorojenckov. REZULTATI: V poteku nosecnosti nismo pri skupini mater IVF z dvoplodnim izidom nosecnosti ugotovili nic vec vecjih zapletov, kot so hipertenzija v nosecnosti, eklampsija, polisimptomatska gestoza, gestacijski diabetes in grozeci prezgodnji porod kot pri kontrolni skupini. V primerjavi s kontrolno skupino smo ugotovili samo vec krvavitev v prvem trimesecju in manj proteinurije. V poteku in izidu poroda smo v skupini IVF v primerjavi s kontrolno skupino ugotovili nižjo povprecno gestacijsko starost, vec prezgodnjih porodov, vec elektivnih in nujnih carskih rezov in nižjo povprecno težo novorojenckov. ZAKLJUCKI: Ženske, ki zanosijo po postopku IVF-ET in imajo dvoplodni izid nosecnosti, niso nic bolj ogrožene, kot nosecnice po spontani zanositvi. Otroci se sicer rodijo nekoliko prej in so nekoliko lažji, vendar se perinatalni izid novorojenckov ne razlikuje od novorojenckov po spontani zanositvi. «» [Abstract / English version] Twin pregnancy and birth after IVF-ET procedure Author: Sara Korošec, Vinko Boc Mentor: prof.dr. Tomaž Tomazevic, dr.med. Co-mentor: asist.dr. Tanja Premru-Seršen, dr.med. BACKGROUND: In vitro fertilisation and embryo transfer (IVF-ET) has become an effective infertility treatment method since first introduced twenty years ago. The outcome of the procedure can be either a singleton or multiple pregnancy. In the comparative study of singleton pregnancies after an IVF-ET procedure, no greater differences in the course and outcome of the pregnancy and birth were determined. Multiple pregnancy is in itself already a risk factor for the course and outcome of the pregnancy and birth. Its frequency in in-vitro fertilisation is approximately twenty fold in comparison to natural conception which is also why it is one of the main problem areas of pregnancy and birth after an IVF- ET procedure. AIM: The aim of our research is to determine whether the course and outcome of a twin pregnancy and birth after an IVF-ET procedure is different than after spontaneous conception. PATIENTS AND METHODS: The research was retrospective in nature. It included 731 twin pregnancy patients who gave birth to twins between April 1987 and May 1995. Our research group consisted of 94 mothers with twin pregnancy and 188 newborns after an IVF-ET procedure. The research was divided into a cohort and controlled study. In the cohort study the research group was compared to the entire Ljubljana cohort of 637 mothers with twin pregnancy and 1274 newborns resulting from spontaneous conception. In the controlled study the research group was compared with 93 mothers with twin pregnancy and 186 newborns after spontaneous conception. In this group the mothers matched the research group in age, parity and birth year. The course of and complications during the pregnancy, and the course, complications and outcome of the birth as well as the characteristics of the newborns were compared. RESULTS: Certain serious complications during the course of the pregnancy, for example hypertension, eclampsy, polysymptomatic gestosis, gestation diabetes and threatened preterm labours, were no more frequent with the IVF group of mothers with twin pregnancy than with the control group. However more bleeding in the first trimester and less proteinuria were determined in comparison to the control group. During the course of birth and its outcome a lower average gestation age, more premature labours, more elective and urgent caesarean sections and a lower average birth weight were determined for the IVF group than for the control group. CONCLUSIONS: Women who conceive after an IVF-ET procedure and with a twin pregnancy outcome are not subject to any more danger than pregnant women after spontaneous conception. Children are born somewhat earlier and are somewhat lighter, however the perinatal outcome of newborns is no different from that of newborns after spontaneous conception.