不同孕周选择性减胎术对双绒毛膜双胎妊娠孕妇和围生儿结局的影响  

Effect of selective feticide at different gestational weeks in double chorionic twin pregnancies on pregnant women and perineonates outcomes

作　　者：杨楠 Yang Nan(Department of Obstetrics and Gynecology,the General Hospital of Northern War Zone,Shenyang 110016,China)

机构地区：[1]北部战区总医院妇产科,沈阳110016

出　　处：《中国医师进修杂志》2022年第11期1010-1014,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的对比不同孕周选择性减胎术对双绒毛膜双胎妊娠孕妇和围生儿临床结局的影响。方法回顾性分析北部战区总医院2015年1月至2021年6月86例行选择性减胎术的双绒毛膜双胎妊娠孕妇的临床资料。按实施选择性减胎术时孕周进行分组,其中孕14+3~19+6周实施选择性减胎术23例(A组),孕20~27+6周实施选择性减胎术31例(B组),孕≥28周实施选择性减胎术32例(C组)。记录三组减胎术后的分娩孕周、流产、早产、足月产、活产儿、存活儿、活产儿出生体质量、存活儿出生体质量、孕妇并发症、母婴结局、新生儿预后。结果三组分娩孕周、孕妇并发症发生率、流产率和新生儿存活率比较差异无统计学意义(P>0.05);三组早产率、足月产率、活产率、活产儿出生体质量和存活儿出生体质量比较差异有统计学意义(P<0.05),其中A组早产率明显低于C组[21.7%(5/23)比68.8%(22/32)],而足月产率明显高于C组[69.6%(16/23)比28.1%(9/32)],A组活产儿和存活儿出生体质量明显高于B组和C组[(2905.7±580.9)g比(2284.4±416.7)和(2293.8±456.2)g、(2905.7±580.9)g比(2457.1±527.8)和(2359.2±482.4)g],C组活产率明显高于B组[96.9%(31/32)比77.4%(24/31)],差异均有统计学意义(P<0.05)。72例存活儿随访3个月至4年,未发生运动功能障碍和神经系统异常。结论双绒毛膜双胎妊娠孕妇于孕20周前实施选择性减胎术,孕妇并发症较少且围生儿临床结局较好。Objective To compare and analyze the pregnant women and perineonates outcomes of selective feticide at different gestational weeks in double chorionic twin pregnancies.Methods The clinical data of 86 patients with double chorionic twin pregnancies who underwent selective feticide from January 2015 to June 2021 in the General Hospital of Northern War Zone were retrospectively analyzed.The patients were divided into two groups according to different gestational weeks of selective feticide:23 cases at 14+3 to 19+6 gestational weeks(group A),31 cases at 20 to 27+6 gestational weeks(group B),32 cases and at≥28 gestational weeks(group C).The gestational weeks of delivery,abortion,preterm birth,full-term birth,liveborn infants,surviving infants,birth body mass of liveborn infants,birth body mass of surviving infants,complications in pregnant women,pregnant women and perineonates outcomes and neonatal prognosis were recorded.Results There were no statistical differences in gestational weeks of delivery,incidence of complications in pregnant women,abortion rate and neonatal survival rate among three groups(P>0.05);there were statistical differences in preterm birth rate,full-term birth rate,liveborn infants rate,birth body mass of liveborn infants and birth body mass of surviving infants among three groups(P<0.05).The preterm birth rate in group A was significantly lower than that in group C:21.7%(5/23)vs.68.8%(22/32),the full-term birth rate was significantly higher than that in group C:69.6%(16/23)vs.28.1%(9/32);the birth body mass of liveborn infants and birth body mass of surviving infants in group A were significantly higher than those in group B and group C:(2905.7±580.9)g vs.(2284.4±416.7)and(2293.8±456.2)g,(2905.7±580.9)g vs.(2457.1±527.8)and(2359.2±482.4)g,the liveborn infants rate in group C was significantly higher than that in group B:96.9%(31/32)vs.77.4%(24/31),and there were statistical differences(P<0.05).The 72 surviving infants were followed up for 3 months to 4 years,and no motor dysfunction and

关 键 词：妊娠 多胎 妊娠减少 多胎 减胎时机 先天性畸形 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]