不同孕周双绒毛膜双胎妊娠经阴道与经腹减胎术妊娠结局比较  

Outcomes of transvaginal embryo reduction versus transabdominal fetal reduction in dichorionic twin pregnancy with different gestational weeks

作　　者：孔秀丽 史昊 王芳[1] 卜志勤[1] KONG Xiuli;SHI Hao;WANG Fang;BU Zhiqin(Reproductive Medical Center,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院生殖医学中心,郑州450052

出　　处：《郑州大学学报（医学版）》2023年第5期643-646,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金青年基金项目(81801448)。

摘　　要：目的:比较不同孕周经阴道与经腹途径多胎妊娠减胎术的妊娠结局,为选择最佳减胎术式及手术时机提供参考。方法:回顾性分析2013年1月至2019年12月在郑州大学第一附属医院生殖医学中心接受减胎术的455例双绒毛膜双胎妊娠孕妇的临床资料。455例中225例接受早期经阴道胎芽抽吸减胎术(7~9孕周,E-ER组),58例接受晚期经阴道胎芽抽吸减胎术(9~12孕周,术中必要时注射氯化钾,L-ER组),172例行经腹胎心氯化钾注射减胎术(12~24孕周,FR组)。比较3组流产率、抱婴率的差异。采用Logistic回归分析调整混杂因素后不同减胎术对妊娠结局的影响。结果:L-ER组流产率(<28周)和术后4周流产率分别为27.59%和15.52%,高于E-ER组(7.56%和2.22%)和FR组(9.88%和6.98%);L-ER组抱婴率(70.69%)低于E-ER组(92.44%)和FR组(88.95%)(P均<0.017);而E-ER组和FR组流产率(<28周)、术后4周流产率和抱婴率差异均无统计学意义(P均>0.017)。Logistic回归分析显示,调整混杂因素后,相比于L-ER,E-ER(OR=0.176,95%CI为0.078~0.395)、FR(OR=0.311,95%CI为0.136~0.714)的流产风险更低。结论:孕7~9周经阴道胎芽抽吸减胎术和孕12~24周经腹胎心氯化钾注射减胎术妊娠结局相似,均为降低双胎妊娠不良妊娠结局风险的更佳方法。Aim:To compare the outcomes of transvaginal and transabdominal multifetal pregnancy reduction with different gestational weeks so as to determine better reduction timing and method.Methods:Data of 455 twin pregnancies that were reduced to singletons in Reproductive Medical Center of the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2019 were retrospectively assessed.Among 455 pregnant women,225 underwent early transvaginal embryo reduction between gestational week 7-9(E-ER group),58 underwent late transvaginal embryo reduction between gestational week 9-12(L-ER group,added KCI injection if necessary),and 172 underwent transabdominal fetal reduction with KCl injection between gestational week 12-24(FR group).The pregnancy outcomes were compared among the 3 groups.The effects of different reductions on pregnancy outcomes were analyzed by Logistic regression analysis.Results:The rates of miscarriage(<28 weeks)(27.59%)and the miscarriage within 4 weeks after reduction(15.52%)in L-ER group were significantly higher than those in E-ER group(7.56%and 2.22%)and FR group(9.88%and 6.98%),and the rate of taking a baby home in L-ER group(70.69%)was significantly lower than those in E-ER group(92.44%)and FR group(88.95%)(P<0.017);however,no significant differences were observed in the above indexes between E-ER group and FR group(P>0.017).Logistic regression analysis showed that after adjusting confounding factors,E-ER and FR had lower risk of miscarriage(E-ER vs L-ER:OR=0.176,95%CI 0.078-0.395;FR vs L-ER:OR=0.311,95%CI 0.136-0.714).Conclusion:Transvaginal embryo reduction between gestational week 7-9 and transabdominal fetal reduction between gestational week 12-14 are safe ways to reduce the risk of adverse pregnancy outcomes for multifetal pregnancies.

关 键 词：多胎妊娠减胎术 双绒毛膜双胎妊娠 经阴道减胎术 经腹减胎术 流产率 

分 类 号：R714.23[医药卫生—妇产科学]