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中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (11) : 841 -845. doi: 10.3877/cma.j.issn.1674-0785.2019.11.009

所属专题: 超声医学 文献

临床研究

阴道超声引导下多胎妊娠减胎术52例临床分析
顾娟1,(), 王一波1, 韩淑军1, 曹义娟1   
  1. 1. 221000 徐州市中心医院生殖医学中心,东南大学(徐州)生殖医学研究所
  • 收稿日期:2019-04-12 出版日期:2019-06-01
  • 通信作者: 顾娟

Clinical analysis of 52 cases of vaginal ultrasound-guided fetal reduction of multiple pregnancies

Juan Gu1,(), Yibo Wang1, Shujun Han1, Yijuan Cao1   

  1. 1. Reproduction Medical Center, Xuzhou Central Hospital, Southeast University Reproductive Medicine Institute, Xuzhou 221000, China
  • Received:2019-04-12 Published:2019-06-01
  • Corresponding author: Juan Gu
  • About author:
    Corresponding author: Gu Juan, Email:
引用本文:

顾娟, 王一波, 韩淑军, 曹义娟. 阴道超声引导下多胎妊娠减胎术52例临床分析[J/OL]. 中华临床医师杂志(电子版), 2019, 13(11): 841-845.

Juan Gu, Yibo Wang, Shujun Han, Yijuan Cao. Clinical analysis of 52 cases of vaginal ultrasound-guided fetal reduction of multiple pregnancies[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(11): 841-845.

目的

探讨阴道超声引导下选择性减胎术在多胎妊娠中的临床应用。

方法

回顾性分析2013年1月至2018年12月在徐州市中心医院生殖中心就诊的10周以内的多胎妊娠患者52例,行阴道超声引导下选择性减胎术,术后分为减胎单胎组(16例)和减胎多胎组(36例)。另外随机选取同期因不孕症来本中心就诊,经治疗后妊娠的10周以内的单胎和双胎患者共82例作为对照组,分别为对照单胎组(45例)和对照双胎组(37例)。统计其胎儿出生体质量、低体质量出生率、早产率、晚期流产率以及孕期的相关并发症,包括妊娠期糖尿病、妊娠期高血压、产后出血以及胎膜早破发生率。采用独立样本的t检验比较4组患者胎儿出生体质量的差异,采用χ2检验比较4组患者的胎儿低体质量出生率、早产率和晚期流产率以及孕期的相关并发症发生率的组间差异。

结果

52例多胎妊娠减胎成功率为100%,减胎双胎组早期自然流产1例,晚期自然流产4例。减胎双胎组胎儿出生体质量低于减胎单胎组[(2.52±0.48)kg vs(3.41±0.31)kg,t=2.495,P=0.023],而胎儿低体质量发生率高于减胎单胎组(35.5% vs 6.3%,χ2=3.916,P=0.048),晚期流产率(25.7%)以及早产率(33.3%)均高于减胎单胎组(P=0.043、0.013),减胎单胎组晚期流产率以及早产率均为0,组间差异均具有统计学意义。与对照组相比,减胎单胎组与对照单胎组、减胎双胎组与对照双胎组胎儿出生体质量、低体质量发生率、晚期流产率以及早产率比较,差异均无统计学意义(P均>0.05)。减胎双胎组妊娠期高血压、妊娠期糖尿病以及产后出血与减胎单胎组比较,差异均无统计学意义(P均>0.05),但胎膜早破发生率高于减胎单胎组(45.2% vs 6.3%),差异具有统计学意义(χ2=5.672,P=0.017)。

结论

阴道超声引导下选择性减胎术能改善多胎妊娠的妊娠结局,是一项安全、有效的临床技术。

Objective

To explore the clinical application of selective fetal reduction guided by transvaginal ultrasound in multiple pregnancies.

Methods

A retrospective analysis was performed on 52 cases of multiple pregnancies within 10 weeks from January 2013 to December 2018 at the Reproduction Medical Center of our hospital. All patients underwent selective reduction under the guidance of transvaginal ultrasound. After operation, they were divided into either a single-fetus group or a multiple-fetus group. In addition, 82 cases of single and twin pregnancies within 10 weeks after treatment were randomly selected as a single-fetus control group and multiple-fetus control group, respectively. Fetal birth weight, low birth weight rate, premature birth rate, and late abortion rate, as well as the related complications during pregnancy, including gestational diabetes mellitus, gestational hypertension, postpartum hemorrhage, and premature rupture of membranes, were recorded. The four groups of subjects were compared for the above indicators.

Results

The successful rate of fetal reduction in the 52 cases of multiple pregnancies was 100%. In the twin pregnancy group after fetal reduction, there was one case of early spontaneous abortion and four cases of late spontaneous abortion. The incidence of fetal birth weight in the multiple-fetus group was significantly lower than that in the single-fetus group [(2.52±0.48) kg vs (3.41±0.31) kg, t=2.495, P<0.05], while the low birth weight rate was significantly higher than that in the single-fetus group (35.5% vs 6.3%, χ2=3.916, P<0.05). The late abortion rate and premature delivery rate in the multiple-fetus group were significantly higher than those in the single-fetus group (25.7% vs 0; 33.3% vs 0, P=0.043、0.013). Both the single-fetus group and multiple-fetus group had similar birth weight, low birth weight, late abortion rate, and premature delivery rate compared with their respective control groups (P>0.05). There was no difference between the single-fetus group and multiple-fetus group in pregnancy hypertension, gestational diabetes mellitus, or postpartum hemorrhage (P>0.05), but the incidence of premature rupture of membranes was significantly higher in the multiple-fetus group than in the single-fetus group (45.2% vs 6.3%, χ2=5.672, P=0.017).

Conclusion

Vaginal ultrasound-guided selective fetal reduction can significantly improve the pregnancy outcome of multiple pregnancies, representing a safe and effective clinical procedure.

表1 4组新生儿出生结局比较
表2 减胎组孕妇妊娠期并发症发生情况比较(%)
1
Zhang YL, Wang XY, Wang F, et al. Clinical analysis of spontaneous pregnancy reduction in the patients with multiple pregnancies undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer [J]. J Clin Exp Med, 2015, 8(3): 4575-4580.
2
Običan S, Brock C, Berkowitz R, et al. Multifetal Pregnancy Reduction [J]. Clin Obstet Gynecol, 2015, 58(3): 574-584.
3
Zipori Y, Haas J, Berger H, et al. Multifetal pregnancy reduction of triplets to twins compared with non-reduced triplets: a meta-analysis [J]. Reprod Biomed Online, 2017, 35(3): 296-304.
4
Practice Committee of Society for Assisted Reproductive Technology, Practice Committee of American Society for Reproductive Medicine. Elective single-embryo transfer [J]. Fertil Steril, 2012, 97(4): 835-842.
5
Martin JA, Hamilton BE, Osterman MJ. Three decades of twin births in the United States, 1980-2009 [J]. NCHS Data Brief, 2012(80): 1-8.
6
Martin JA, Hamilton BE, Osterman MJ, et al. Births: final data for 2015 [J]. Natl Vital Stat Rep, 2017, 66(1): 1.
7
朱依敏, 张丹, 黄荷凤. 医源性多胎的危害及防控 [J]. 中国计划生育与妇产科, 2012, 4(2): 5-8.
8
汪雪雁, 肖兵, 熊庆. 多胎妊娠营养 [J]. 实用妇产科杂志, 2006, 22(5): 264-266.
9
The ESHRE Capri Workshop Group. Multiple gestation pregnancy [J]. Hum Reprod, 2000, 15(5): 1856-1864.
10
Committee on Practice Bulletins-Obstetrics, Society for Maternal-Fetal Medicine. Practice Bulletin No. 169: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies [J]. Obstet Gynecol, 2016, 128(4): e131-e146.
11
American College of Obstetricians and Gynecologists′ Committee on Obstetric Practice, Committeeon Genetics, U.S. Food and Drug Administration. Committee Opinion No. 671: Perinatal risks associated with assisted reproductive technology [J]. Obstet Gynecol, 2016, 128(3): e61-e68.
12
Scher AI, Petterson B, Blair E, et al. The risk of mortality or cerebral palsy in twins: a collaborative population-based study [J]. Pediatr Res, 2002, 52(5): 671-681.
13
Dickey RP, Taylor SN, Lu PY, et al. Spontaneous reduction of multiple pregnancy: incidence and effect on outcome [J]. Am J Obstet Gynecol, 2002, 186(1): 77-83.
14
邹薇薇, 徐千花, 向卉芬, 等. 辅助生殖技术(ART)助孕获得多胎妊娠行减胎术后妊娠结局观察 [J]. 生殖与避孕, 2013, 33(1): 63-66.
15
heang CU, Huang LS, Lee TH, et al. A comparison of the outcomes between twin and reduced twin pregnancies produced through assisted reproduction [J]. Fertil Steril, 2007, 88(1): 47-52.
16
周灿权, 李洁, 梁晓燕, 等. 多胎妊娠减胎术45例临床效果分析[J]. 中国实用妇科与产科杂志, 2002, 11(18): 667-669.
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