不同绒毛膜性三胎妊娠减胎术后妊娠结局分析  

Analysis of Pregnancy Outcomes After Fetal Reduction in Monochorionic, Dichorionic, and Trichorionic Triplet Pregnancies

作　　者：黄淼 刘希婧 龚云辉 HUANG Miao;LIU Xi-jing;GONG Yun-hui(Department of Obstetrics,West China Second University Hospital,Sichuan University,Chengdu 61004,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 61004,China)

机构地区：[1]四川大学华西第二医院产科,成都610041 [2]出生缺陷与相关妇儿疾病教育部重点实验室(四川大学),成都610041

出　　处：《四川大学学报（医学版）》2023年第2期426-431,共6页Journal of Sichuan University(Medical Sciences)

基　　金：成都市科技局国际合作项目(No.2019-GH02-00058-HZ)资助。

摘　　要：目的 比较不同绒毛膜性三胎妊娠接受减胎治疗后的妊娠结局。方法 回顾性分析2012年1月1日–2021年1月31日于四川大学华西第二医院接受规律产检并住院分娩的三胎妊娠孕妇临床资料共118例。根据绒毛膜性分为单绒毛膜组(n=13)、双绒毛膜组(n=44)及三绒毛膜组(n=61),并于每组内根据是否接受减胎治疗,分为减胎亚组和期待治疗亚组。比较各组内减胎亚组与期待治疗亚组之间的临床资料及妊娠结局。结果 单绒毛膜组内,减胎亚组较期待治疗亚组早产率更低、新生儿出生体质量更高,但差异均无统计学意义。双绒毛膜组和三绒毛膜组内,减胎亚组较期待治疗亚组早产率、新生儿住院率及严重并发症发生率更低(P<0.05),新生儿出生体质量更高(P<0.05)。双绒毛膜组内,减胎亚组妊娠期肝内胆汁淤积症发生率低于期待治疗亚组(P=0.03)。3组内,妊娠期糖尿病、妊娠期高血压疾病、胎膜早破及产后出血发生率在减胎亚组与期待治疗亚组之间的差异无统计学意义。生存曲线分析提示,孕早期减胎较孕中期减胎发生妊娠丢失的风险更低,孕周延长更显著。结论 三胎妊娠行减胎术后可显著延长孕周,改善围产儿预后,且孕早期行减胎术可能较孕中期获益更大。Objective To compare the pregnancy outcomes of pregnancy outcomes after selective fetal reduction treatment in monochorionic, dichorionic, and trichorionic triplet pregnancies. Methods We conducted a retrospective analysis of the clinical data of 118 pregnant women carrying triplets. All subjects underwent regular prenatal check-ups and were admitted for delivery at West China Second University Hospital, Sichuan University between January1, 2012 and January 31, 2021. According to the chorionicity, the subjects were divided into a monochorionic group(n=13), a dichorionic group(n=44), and a trichorionic group(n=61). Within each group, the subjects were further divided into two subgroups, a reduction group and an expectant treatment group, according to whether they underwent fetal reduction or not. The clinical data and pregnancy outcomes were compared between the subgroups within each group.Results In the monichorionic group, the reduction subgroup had a lower preterm birth rate and higher neonatal birth body mass than those of the expectant management subgroup, but the differences were not statistically significant. In the dichorionic and trichorionic groups, the rates of preterm delivery, neonatal hospitalization, and serious complications of the reduction subgroups were lower than those of the expectant subgroups(P<0.05), while the neonatal birth body mass was higher in the reduction subgroups than that in the expectant subgroups(P<0.05). In the dichorionic group, the incidence of intrahepatic cholestasis during pregnancy was lower in the reduction subgroup than that in the expectant treatment subgroup. In all 3 groups, there was no statistically significant difference between the subgroups in the incidence of gestational diabetes, hypertensive disorders of pregnancy, premature rupture of membranes, and postpartum hemorrhage. The survival curve analysis showed that women receiving fetal reduction during the first trimester had a lower risk of pregnancy loss and more significant prolonged of gestational age than

关 键 词：三胎妊娠 减胎术 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]