对三胎妊娠孕妇实施减胎术后双胎或单胎的妊娠结局及流产发生风险的分析  

Clinical analysis of pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy

作　　者：李善玲[1] 王谢桐[1] 李红燕[1] 王燕芸[1] 侯海燕[1] 

机构地区：[1]山东大学附属省立医院妇产科,济南250021

出　　处：《中华妇产科杂志》2015年第4期268-273,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：探讨对三胎妊娠孕妇实施减胎术后双胎或单胎的妊娠结局及流产发生风险的分析。方法收集2001年9月-2014年3月在山东大学附属省立医院妇产科实施减胎术的三胎妊娠孕妇282例（其中自然受孕11例，其余均为辅助生殖技术助孕），根据保留胎儿数目分成由三胎妊娠减至双胎者231例（双胎组），由三胎妊娠减至单胎者51例（单胎组）。双胎组因胎儿畸形和孕妇要求减至双胎；单胎组因孕妇要求和双绒毛膜三羊膜囊三胎妊娠减至单胎。减胎术采用目标胎儿心内注射氯化钾法。至少1个新生儿存活为妊娠成功，分析两组妊娠结局、妊娠终止孕周、新生儿出生体质量等。结果（1）总妊娠成功率为91.5%（258/282），双胎组新生儿总数为413例，除去4例死亡新生儿，新生儿存活409例，妊娠成功率为90.5%（209/231）；单胎组新生儿总数为49例，除去2例孕中期流产，妊娠成功率为96.1%（49/51），两组新生儿存活率比较，差异无统计学意义（P〉0.05）。（2）双胎组减胎时平均孕周为（16.5±3.5）周，单胎组为（14.2±2.0）周，将减胎孕周分为孕11-13周＋6、孕14-16周＋6、≥17孕周3个时段，双胎组孕妇分别为129例（55.8%，129/231）、50例（21.6%，50/231）、52例（22.5%，52/231）；单胎组孕妇分别为27例（53%，27/51）、16例（31%，16/51）、8例（16%，8/51），两组不同减胎孕周时段的孕妇比例比较，差异均无统计学意义（P〉0.05）。（3）双胎组孕11-13周＋6、孕14-16周＋6、≥17孕周流产率分别为7.0%（9/129）、12%（6/50）、10%（5/52）；单胎组分别为4%（1/27）、0（0/16）、1/8，两组不同孕周流产率分别比较，差异均无统计学意义（P〉0.05）。（4）双胎组和单胎组新生儿平均出生体质量分别为（2555±447）及（3084±550）g，两组比较，差异有统计学意义（P〈0.05）。双胎组及单胎组低出生�Objective To investigate and evaluate the pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy. Methods 282 cases of triplets who received multi-fetal pregnancy reduction （MFPR） at Shandong Provincial Hospital affiliated to Shandong University were recruited from Sep 2001 to Mar 2014. According to the remaining fetal number after MFPR, 231 cases were opted to reduce to twins （twins group） while 51 cases were opted to singleton pregnancy （singleton group）.The indication of the former group was fetal abnormalities under ultrasound or on patients′ demand; while the indication for the later group included dichorionic triamniotic （DCTA） triplets or patients′ aspiration. Potassium chloride was injected into the targeted fetal heart until cardiac standstill was obtained. The pregnancy outcomes, gestational age at delivery, birth weight of newborns of the two groups were recorded. Successful pregnancy was defined as take-home at least one baby. Results （1）The overall rate of successful pregnancy was 91.5%（258/282）.There were 413 neonates in the twins group, including 4 neonatal deaths and 409 live babies, with the successful rate of 90.5%（209/231）. There were 49 neonates in the singleton group, including 2 cases of fetal loss. Thus the successful rate was 96.1%（49/51）. There was no difference of successful pregnancy rate between the two groups（P〉0.05）.（2）The mean gestational age at operation for the twins group and singleton group were（16.5±3.5）weeks and （14.2±2.0） weeks, respectively. Each group was divided into three periods,11-13＋6 weeks, 14-16＋6 weeks and≥17 weeks.In the twins group, the cases in each time period were129（55.8%,129/231）, 50（21.6%,50/231）and 52（22.5%,52/231）, respectively. While in the singleton group, the cases in each time period were 27（53%,27/51）, 16（31%, 16/51）and 8（16%,8/51）.There was no difference between the two groups at each time period（P〉0.05）. （3）The

关 键 词：妊娠 三胎 妊娠减少 多胎 妊娠 双胎 妊娠结局 

分 类 号：R714.5[医药卫生—妇产科学]