体外受精-胚胎移植后三胎妊娠减胎术结局分析

The outcome of selective reduction of triplet pregnancy after in vitro fertilization-embryo transfer

目的分析早期选择性减胎术对妊娠并发症和新生儿的影响,评价其安全性。方法收集本中心2000年1月至2003年2月经体外受精胚胎移植(IVF ET)和卵胞浆内单精子注射(ICSI)受孕的三胎妊娠减灭为双胎妊娠35例(A组)及同期双胎妊娠166例(B组)。比较两组妊娠期并发症、剖宫产率、围产期死亡率、新生儿畸形率、平均出生体重及孕周。结果两组自然流产率、妊娠高血压综合征发生率、分娩率、剖宫产率、早产率、围产期死亡率、畸形率、平均出生孕周差异均无显著性;胎膜早破率和先兆早产率A组分别为30%、7.7%,B组分别为13%、56%,两组比较差异有显著性(P<0.05);平均出生体重A组(2410.8±570.0)g,明显低于B组(2560.9±530.6)g(P<0.05)。结论三胎妊娠早期选择性减胎术后胎膜早破和先兆早产率明显升高,胎儿存在低出生体重可能性。因此,预防多胎妊娠,限制胚胎移植数目,仍然是辅助生育技术实施过程中不可忽视的问题。

Objective: To evaluate the efficacy and safety of selective reduction of triplet pregnancy and its impact on the outcome of pregnancy.Methods: A retrospective study was carried out to measure pregnant complications, Caesarean section rate, perinatal mortality, malformation, birth weight and gestational age in the patients of triplet pregnancy reduced to obtain twins (n=35, group A) and the original twin pregnancy (n=166, group B) resulted from IVF-ET and ICSI treatment between January 2000 to February 2003.Results: No significant differences were found in the miscarriage rate, caesarean section rate, premature delivery rate, neonatal mortality rate, malformation rate and mean gestational age at delivery between the two groups. Incidences of foreboding premature delivery and premature rupture of membrane in group A were significant higher than those of group B (77% versus 56% and 30% versus 13% respectively). Birth weight of infants was significantly lower in group A compared with group B.Conclusion: Selective reduction of triplet pregnancy had a higher incidence of foreboding premature (delivery) and premature rupture of membrane and a higher risk of low birth weight of infants. Therefore, to prevent multiple pregnancies, especially the triplet pregnancy, the number of embryos transferred in IVF procedure should be restricted.