多胎妊娠早期选择性减胎术17例分析

Selective Reduction of Multifetal Pregnancies in the First Trimester:A Report of 17 Cases

目的 :研究多胎妊娠早期选择性减胎术的可行性、安全性及对妊娠的影响。方法 :17例多胎妊娠孕早期在 B超引导下 ,将穿刺针选择性进入 1个或 2个胚胎的心管搏动处 ,反复抽吸或注入少量药物致心搏停止。结果 :14例经阴道减胎术单次成功 ,3例经腹部减胎 2～ 3次成功。 2例足月剖宫分娩 ,2例孕 32周、孕 34周提前剖宫术。 5例晚期流产。2例因感染而分别于术后第 3、第 7天流产。 6例继续妊娠。多胎妊娠的减胎术成功率 88.2 % (15 / 17)。总流产率 41.2 %(7/ 17)。已分娩的 8个新生儿健康。结论 :在 B超引导下 ,多胎妊娠早期选择性减胎术是安全。

Objectives:To evaluate the efficacy and safety of selective reduction of multifetal pregnancies in the first trimester and its impact on the outcome of pregnancy.Materials and Methods:Seventeen cases of multifetal pregnancies underwent first trimester multifetal pregnancy reduction by transvaginal or transabdominal.A17 or 20 gauge,30 cm or 15 cm needle was introduced into one or two of the sacs under ultrasound guidance and directed into the fetal chest,where repeated aspiration was performed or potassium chloride was injected.After asystole was visualized,the needle was removed.Results:Fourteen cases performed once by transvaginal procedures.Three cases underwent multifetal reduction two or three times transabdominally.Four cases delivered by cesarean section including two at>37 weeks and two at 32 weeks and 34 weeks respectively.Five patients were aborted at 16～24 weeks.Two cases were aborted three to seven days after the precedure.of multifetal pregnancy reduction.Six patients are ongoing pregnancy.The success rate of multifetal pregnancy reduction was 88.2%.The pregnancy loss rate(<26 weeks)was 41.2%.All infants are healthy.Conclusions:Multifetal pregnancy reduction by transvaginal or transabdominal is a relatively safe and effecient method for improving outcome in multifetal pregnancy.