促排卵后孕16周五胎妊娠减胎1例

Pregnancy Reduction of A Quintuplet Pregnancy Following Ovulation Induction at 16-week Gestation

目的:报道1例门诊促排卵后五胎妊娠减胎术。方法:28岁女性,PCOS史,门诊hMG促排卵治疗,卵泡成熟后注射hCG。自然受孕,孕15周就诊,B超提示五绒毛膜五羊膜囊五胎妊娠,于孕16周在B超引导下,使用脐静脉穿刺针穿刺进入胎心,向2个胎心分别注入100 mg/ml KC1行减胎术,3 d后同法再减一胎。结果:顺利减灭三胎,无不适主诉,无腹痛、阴道出血等。孕36+3周顺产二子,体健。结论:PCOS患者促排卵应采用低剂量FSH,缓慢加量,排卵后应加强随访。减胎术可降低多胎妊娠的不良影响,但更应避免其发生。

Objective： To report a case of quintuplet pregnancy reduction following outpatient induction.Methods： A 28-year-old female,who had a history of PCOS,underwent outpatient ovulation induction using hMG.When follicles were mature,hCG was injected.After natural conception,the patient went to clinic at 15-week gestation,and transvaginal ultrasound revealed quintuplet pregnancy.Ultrasound-guided pregnancy reduction was per-formed at week 16.Using umbilical cord puncture needle,two of the fetal hearts were punctured,and 100 mg/ml KCl was injected into these two fetal hearts,respectively.Three days later,one more fetus was reduced using the same method.Results： Triplets were terminated successfuliy,and the patient had no main complaint,with no abdominal pain or vaginal bleeding,etc.Two healthy boys were delivered by natural labor at 36＋3-week gestation.Conclusion： Ovulation induction in PCOS patients should use low dose FSH,and increase this dose slowly.After ovulation,more attention shoud be paid to follow-up.Pregnancy reduction can diminish the undesirable effects of high-order multiple pregnancy,more importantly,we should avoid the incidence of multiple pregnancy.