多胎妊娠早期经阴道B超引导下选择性减胎术的临床应用

Clinical application of elective embryo reduction by the transvaginal ultrasound-guided technique in early stage of multiple pregnancy

目的 总结多胎妊娠早期实施选择性减胎术的应用价值及体会。方法 在阴道B超引导下 ,对 9例通过辅助生殖技术妊娠的多胎患者 ,采用药物或结合机械法减灭胚胎。结果 在 9例患者中减为双胎 7例 ,减为单胎 2例 ,减胎时孕龄为 6+ 5～ 7+ 3 周 ,减胎前总胚胎数 2 8个 ,共减灭胚胎 12个。无一例感染及早期胚胎丢失。减胎的成功率为 10 0 %。 2例单胎妊娠全部足月分娩 ,无低出生体重儿及围产儿死亡 ;7例双胎妊娠中 ,晚期流产 1例 ,早产 4例 ,早产发生率 5 7.14 % (4 /7) ,低出生体重儿占 5 5 .5 6% (5 /9) ,围产儿病死率 3 5 .71% (5 /14 )。结论 尽管选择性减胎术对辅助生育技术中出现的多胎妊娠是有效的补救措施 ,但应从多方面控制和重视多胎妊娠 ,减少不良妊娠结局。

Objective To summarize the experience and realization of elective embryo reduction in early stage of multiple pregnancy.Methods 9 cases with multiple pregnancy resulting from assisted reproductive technique received elective embryo reduction with drug method or drug combinded mechanical damage method by the transvaginal ultrasound-guided technique.Results 9 cases were reduced to twins (n=7) or singletons (n=2) at early gestational age (6 +5 ～7 +3 weeks). 12 embryos were reduced in the total of 28 embryos, there were no infection and early miscarriage. The success rate of operation was 100%. 2 cases singletons all delivered at term, low birth weight infant and perinatal mortality rate were 0%(0/2). In 7 cases twins 1 case was late abortion and 4 cases were preterm labor, the rate of preterm labor and occurring low birth weight infant were 57.14%(4/7) and 55.56%(5/9), respectively, perinatal mortality rate was 35.71%(5/14).Conclusion Elective embryo reduction in early stage is an effective alternative for the management of multiple pregnancy in assisted reproduction, but we must control multiple pregnancy and decrease disadvantageous outcome.