双绒毛膜多胎妊娠不同孕周选择性减胎术后临床结局分析  

Clinical Outcomes of Selective Feticide in Dichorionic Multiple Pregnancies

作　　者：邓春艳 胡青 廖华 王晓东 余海燕 DENG Chunyan;HU Qing;LIAO Hua(Department of Obstetrics and Gynecology,West China Second University Hospital,Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University Ministory of Education,Chengdu Sichuan 610041,China)

机构地区：[1]四川大学华西第二医院妇产科出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《实用妇产科杂志》2021年第1期47-51,共5页Journal of Practical Obstetrics and Gynecology

基　　金：四川省科技厅重点研发项目(编号:2018FZ0041);四川省学术和技术带头人培养支持经费项目(编号:川人社办发[2017]919-25)。

摘　　要：目的:探讨双绒毛膜多胎妊娠不同孕周选择性减胎术后的临床结局。方法:回顾性分析2012年1月至2018年12月98例双绒毛膜多胎妊娠于四川大学华西第二医院进行选择性减胎术的临床资料,根据实施减胎术孕周分为3组:G1组(孕14~19+6周,19例)、G2组(孕20~27+6周,30例),G3组(≥孕28周,49例),比较不同孕周行选择性减胎术后的临床结局。结果:①98例中行选择性减胎术原因包括染色体异常(25例)、胎儿结构畸形(68例)及其他母胎合并症(5例)等。②G1组母体无相关并发症发生;减胎术后2周G2组母体发生胎膜早破2例,宫内感染2例;G3组发生胎膜早破4例,宫内感染2例。③减胎术后流产发生率为8.2%、早产发生率为50.0%,活产儿存活率94.6%。3组分娩孕周差异无统计学意义(P>0.05)。G1组流产率显著低于G2组(10.5%vs 20.0%,P<0.05);G1组的活产儿出生体质量及存活儿出生体质量也优于G2组(P<0.05);G1组的早产率、足月产率、活产儿出生体质量及存活儿出生体质量均优于G3组(P<0.05)。结论:在孕20周前对双绒毛膜多胎妊娠行选择性减胎术,其妊娠结局较好,合理使用选择性减胎技术,可以有效减灭异常胎儿和多胎妊娠的胎儿数量,减少多胎妊娠的并发症及合并症,改善多胎妊娠母胎结局。Objective:To investigate the clinical outcomes of selective feticide in different gestational weeks of dichorionic multiple pregnancies.Methods:Selective feticide of dichorionic multiple pregnancies in West China Second University Hospital between January 2012 and December 2018 was retrospectively analyzed.Included patients were distributed into 3 groups according to their gestational weeks:G1 group included patients with 14-19+6 weeks of gestation;G2 group included patients with 20-27+6 weeks of gestation;G3 group included patients with>28 weeks of gestation.Results:①Ninety-eight women underwent selective feticide with indications of chromosome abnormality(25 cases),fetal malformation(68 cases)or other maternal-fetal complications(5 cases).②No complications were observed in G1 group;Premature rupture of membranes(PROM)(2 cases)and intrauterine infection(2 cases)were observed in G2 group within 2 weeks after operation;In G3 group,PROM occurred in 4 cases and intrauterine infection in 2 cases.③The abortion rate was 8.2%,premature delivery rate was 50.0%,and the live birth rate was 94.6%.No significant differences in gestational week were observed among three groups(P>0.05).The abortion rate in G1 group was significantly lower than that in G2 group(10.5%vs.20.0%,P<0.05).The birth weight of both liveborn and surviving infants in G1 group was also higher than that in G2 group(P<0.05).The preterm birth rate,full-term birth rate,birth weight of liveborn and surviving infants in G1 group were higher than those in G3 group(P<0.05).Conclusions:The outcomes selective feticide in dichorionic multiple pregnancies were better before 20 weeks of gestation.Selective feticide technology can effectively reduce the number of abnormal fetuses,prevent the complications of multiple pregnancies,and improve the maternal-fetal outcomes.

关 键 词：双绒毛膜多胎妊娠 胎儿畸形 选择性减胎 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]