双绒毛膜三羊膜囊三胎妊娠孕中期不同减胎方法的妊娠结局  

Perinatal outcome of different approaches for second-trimester multifetal pregnancy reduction in women with dichorionic triamniotic triplet pregnancies

作　　者：赵馨[1] 黄演林[1] 何薇[1] 熊盈[1] 刘倩[1] 尚宁[1] 陈丹[1] 肖祎炜[1] 石礼双 黄华梅[1] 吴菁[1] Zhao Xin;Huang Yanlin;He Wei;Xiong Ying;Liu Qian;Shang Ning;Chen Dan;Xiao Yiwei;Shi Lishuang;Huang Huamei;Wu Jing(Medical Genetics Center,Guangdong Women and Children Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院医学遗传中心,广州511400

出　　处：《中华围产医学杂志》2021年第4期254-260,共7页Chinese Journal of Perinatal Medicine

基　　金：广东省医学科学技术研究基金(A2020302)。

摘　　要：目的比较分析双绒毛膜三羊膜囊(dichorionic triamniotic,DCTA)三胎妊娠孕中期行不同减胎术的妊娠结局。方法回顾性分析2014年1月至2020年1月在广东省妇幼保健院孕中期行减胎术的51例DCTA三胎妊娠孕妇的病历资料,根据减胎术的指征,分为预防组(39例)和治疗组(12例),每组再根据不同的减胎方法分为射频消融(radiofrequency ablation,RFA)减胎术组(保留双绒毛膜双胎)、氯化钾-单组(氯化钾心脏注射减胎保留单绒毛膜单胎)、氯化钾-双组(氯化钾心脏注射减胎保留单绒毛膜双胎)。比较预防组和治疗组组内及组间流产率、分娩孕周、出生体重、胎儿宫内死亡、新生儿死亡等差异。组间比较采用t检验、方差分析或χ^(2)检验或Fisher精确概率法,组内两两比较采用Bonferroni方法校正。结果(1)治疗组减胎手术孕周大于预防组[(18.5±3.1)与(15.0±2.3)周,t=-4.209,P<0.001];预防组中RFA减胎手术孕周大于氯化钾-单及氯化钾-双组[(17.2±1.6)与(13.8±1.5)、(12.7±1.0)周,t值分别6.630和3.875,P值均<0.05]。(2)预防组减胎术后流产率低于治疗组[10.3%(4/39)与5/12,Fisher精确概率法,P<0.05],活产儿比例高于治疗组[85.7%(48/56)与10/18,χ^(2)=5.640,P=0.018]。预防组中氯化钾-单组无出生体重<1500 g,组内不同减胎方法比较差异有统计学意义(P<0.05),但两两比较并无统计学意义。治疗组不同减胎方法活产儿比例比较差异有统计学意义,其中RFA组高于氯化钾-双组(6/6与1/6,Fisher精确概率法,P=0.015)。2组中3种不同减胎方法的流产率、分娩孕周、出生体重、<32周分娩、足月分娩的发生率比较差异均无统计学意义(P值均>0.05)。(3)母胎并发症中,预防组和治疗组的RFA组与氯化钾-单组均未发生单绒毛膜双胎并发症和围产期死亡。2组中共5例(10个胎儿)行氯化钾心脏注射减胎保留单绒毛膜双胎,其中4个胎儿流产,3个胎儿宫内死亡、无新生儿死亡,3个胎�Objective To explore the effects of different approaches for second-trimester multifetal pregnancy reduction on pregnancy outcome in women with dichorionic triamniotic(DCTA)triplet.Methods A retrospective study was performed on 51 women with DCTA triplet pregnancies who were referred to Guangdong Women and Children Hospital for second-trimester multifetal pregnancy reduction from January 2014 to January 2020.All participants were divided into either preventive group(n=39)or treatment group(n=12)according to the indication for multifetal pregnancy reduction,and they were further allocated to three subgroups based on different reduction methods,which were reduction to dichorionic twin by radiofrequency ablation(RFA)(RFA subgroup),reduction to monochorionic singleton(KCl-singleton subgroup)or monochorionic twin(KCl-twin subgroup)by cardiac injection of potassium chloride.Pregnancy loss rate,neonatal birth weight,gestational age at delivery,incidence of intrauterine death,and neonatal death were compared and analyzed between different groups using t-test,analysis of variance,Chi-square test,Fisher's exact test and Bonferroni correction.Results(1)The mean gestational week at operation in the treatment group was significantly later than that in the preventive group[(18.5±3.1)vs(15.0±2.3)weeks,t=-4.209,P<0.001].In the preventive group,the mean gestational week at operation in the RFA subgroup was later than the KCl-singleton and KCl-twin subgroup[(17.2±1.6)vs(13.8±1.5)and(12.7±1.0)weeks,t=6.630 and 3.875,respectively,both P<0.05].(2)The postoperative pregnancy loss rate in the preventive group was decreased compared with the treatment group[10.3%(4/39)vs 5/12,Fisher's exact test,P<0.05],and the live birth ratio was increased[85.7%(48/56)vs 10/18,χ^(2)=5.640,P=0.018].No live birth infants with birth weight<1500 g was reported in the KCl-singleton subgroup in preventive group,and the statistical significance was observed in the intra-group differences(P<0.05)rather than the pairwise comparison differences in the pre

关 键 词：妊娠 三胎 妊娠减少 多胎 射频消融术 氯化钾 注射 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]