Safety Study Of Twin Pregnancy Vaginal Delivery After IVF

Objective:This paper reviews the data of twin pregnancy after IVF,compares the maternal and neonatal outcomes of vaginal delivery and cesarean section,analyzes the factors influencing vaginal delivery and adverse maternal and neonatal outcomes.At the same time,to discuss the safety of vaginal delivery of twin pregnancy after IVF and to guide the clinical management,so as to further improve the delivery quality of twin pregnancy after IVF.Methods:We retrospectively analyzed the clinical data of 241 cases of twin pregnancy after IVF who delivered in our hospital between January 2015 to January 2020,excluding cases with incomplete information.The patients were divided into two groups,91 cases of vaginal delivery as the observation group and 150 cases of cesarean section as the control group.The general situation,pregnant complications,maternal and neonatal outcome of the two groups were compared.And the factors influencing the success of vaginal delivery,postpartum hemorrhage and neonatal asphyxia were analyzed by logistic regression.Results:① There was no significant difference in age and gestational week between the two groups.The hospital stay and proportion of primipara in cesarean section group were significantly higher than that in vaginal delivery group(P<0.05).②There were more complications in cesarean section group,and the proportion of hypertensive disorders was significantly higher than that in vaginal delivery group(P<0.05).③ Maternal and neonatal outcome:there was no difference in the incidence of postpartum hemorrhage between two groups,but the amount of postpartum hemorrhage in the cesarean section group was higher than that in the vaginal delivery group,the difference was statistically significant(P<0.05);The neonatal asphyxia rate in the cesarean section group was lower than that in the vaginal delivery group,the difference was statistically significant(P<0.05).④ Logistic regression analysis showed that the risk factors of vaginal delivery included:primipara(OR=0.226,95%CI:0.096-0.534),non-vertex presentation of twin B(OR=0.480,95%CI:0.247-0.935),hypertensive disorder complicating pregnancy(OR=0.177,95%CI:0.053-0.595),while the protective factor of vaginal delivery was cervix balloon for labor induction(OR=2.412,95%CI:1.052-5.529).⑤The risk factors of postpartum hemorrhage in vaginal delivery group were:uterine atony,anemia during pregnancy,interval time(≥20min).⑥ The risk factors of neonatal asphyxia after vaginal delivery included:interval time(≥20min),hypertensive disorder during pregnancy.⑦ The neonatal asphyxia rate was the lowest in 35+1-37 weeks,the highest in less than 38 weeks(P<0.05),and the proportion of low birth weight infants began to decrease significantly after 35 weeks(P<0.05).Conclusion:To strengthen prenatal education,prevent and treat pregnancy complications can reduce the cesarean section rate of twin pregnancy after IVF;Vaginal delivery of twin pregnancy after IVF will not increase the incidence of postpartum hemorrhage,but may increase the risk of neonatal asphyxia;Primipara,non-vertex presentation of twin B,hypertensive disorder are risk factors for vaginal delivery,while cervix balloon for labor induction can improve the rate of vaginal delivery;Active treatment of anemia during pregnancy and uterine atony can reduce the incidence of postpartum hemorrhage during vaginal delivery;Actively prevent and treat hypertension disorder can reduce the neonatal asphyxia rate during vaginal delivery;Strictly control the interval time between the delivery of two fetuses during vaginal delivery can improve the maternal and neonatal outcome;It is recommended to terminate pregnancy after at least 35 weeks for women with twin pregnancy after IVF,which will get a better neonatal outcome.