Twin Pregnancies Conceived Spontaneously and by ART (Assisted Reproductive Technologies) – a Retrospective Analysis and Review

Abstract

Purpose: The aim of this study was to compare the perinatal and maternal outcome of our own cohort of twin pregnancies after IVF/ICSI and spontaneous conception to the respective available standards and findings in the current literature. Material and Methods: Perinatal and maternal data of 305 twin pregnancies conceived spontaneously and 74 pregnancies conceived by IVF/ICSI were compared. The following parameters were examined: maternal age, first parity, gestational age, Caesarean section rate, birth weight, sex constellation, umbilical arterial blood pH of the first and second child, maternal complications, fetal malformations, perinatal and neonatal mortality. These data were tested by retrospective statistical analysis (Fisher exact test, Wilcoxon Rank Sum Test). In addition, these parameters were also evaluated separately in dichorionic/diamniotic twins and monochorionic/diamniotic twins. Results: We found significant differences with higher maternal age, higher rate of first parity, an increased incidence of pre-eclampsia and a lower rate of SGA (VLBW) in the ART group and ART subgroup (di/di) compared to the SC group. Caesarean section rate, birth weight, arterial pH of the first and second twin, prematurity, rate of malformations, perinatal and neonate mortality, respectively, were not significantly different between the two groups. For prematurity < 37 weeks of gestation, a significantly higher frequency of the male/male sex constellation was observed. Conclusion: Actually, we are now able to more specifically counsel women conceiving by IVF/ICSI concerning maternal and perinatal outcome.

Zusammenfassung

Fragestellung: Ziel der Studie ist der Vergleich zwischen dem perinatologischen und maternalen Outcome unserer eigenen Zwillingsschafts-Kohorte nach ART (IVF/ICSI) und spontaner Konzeption (SC) im Vergleich zu den verfügbaren Standards und Suchergebnissen der vorhandenen Literatur. Material und Methoden: Verglichen wurden die perinatalen und maternalen Daten von 305 spontan konzipierten Zwillingsschwangerschaften zu 74 Geminigraviditäten nach IVF/ICSI. Die folgenden Parameter wurden untersucht: mütterliches Alter, Erstparität, Schwangerschaftwoche, Sectiorate, Geburtsgewicht, Geschlechtskonstellation, arterieller Nabelschnur-pH des 1. und 2. Kindes, maternale Komplikationen, fetale Fehlbildung, perinatale und neonatale Mortalität. Diese Daten wurden einer retrospektiven statistischen Analyse mittels Fisher-Exact-Test, Wilcoxon-Rangsummen-Test unterzogen. Weiterhin wurden diese Daten nach Dichorializität/Diamnializität und Monochorializität/Biamnializität aufgeschlüsselt. Ergebnisse: Wir fanden signifikante Differenzen mit höherem maternalen Alter, höherer Rate von Erstparität und einer ansteigenden Inzidenz von Präeklampsie sowie eine niedrigere Rate von SGA (VLBL) in der ART-Gesamtgruppe und ART-Subgruppe (Dichorializität/Diamnializität) im Vergleich zur SC-Gruppe. Die Sectiorate, das Geburtsgewicht, der umbilikale arterielle pH des 1. und 2. Zwillings, Frühgeburtlichkeit, Malformationsrate, perinatale und neonatale Mortalität zeigten keine signifikanten Unterschiede in der ART- oder SC-Gruppe. Für die Frühgeburtlichkeit < 37. SSW wurde eine höhere Frequenz der männl./männl. Geschlechtskonstellation beboachtet. Schlussfolgerung: Tatsächlich sind wir in der Lage, eine exaktere Beratung von Frauen nach IVF/ICSI-Konzeption hinsichtlich des maternalen und perinatalen Outcomes durchzuführen.

Key words

twins - ART - IVF/ICSI - preeclampsia - gender constellation

Schlüsselwörter

Zwillinge - künstliche Befruchtung - IVF/ICSI - Präeklamspie - Geschlechterkonstellation

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