多胎妊娠的选择性减胎及临床预后分析

Analysis on clinical prognosis of selective pregnancy reduction of multiple pregnancy

目的：探讨多胎妊娠选择性减胎术的临床应用，提高妊娠成功率，降低发生缺陷发生率。方法：选取2003～2013年在该院进行选择性减胎的孕妇36例，早期妊娠根据胚芽大小，超声引导下采用直接抽吸或抽吸＋10％氯化钾注射液胎体注射进行减胎；中、晚期妊娠经腹壁减胎，超声引导下胎儿心脏穿刺回抽见血后于心腔内注射10％氯化钾注射液进行减胎。并对产妇预后情况进行相关性分析。结果：36例孕妇中，早期妊娠22例，中期妊娠11例，晚期妊娠3例，均一次减胎成功，无并发症，一次减胎成功率为100．00％。获得新生儿37名，其中单胎分娩13例，双胎分娩12例。结论：多胎妊娠选择性减胎术是一种安全有效的宫内治疗方法，在进行孕期产前超声筛查后再进行选择性减胎，可以提高妊娠成功率，并预防缺陷儿出生。

Objective： To explore the clinical application of selective pregnancy reduction of multiple pregnancy to improve suc- cessful rate of pregnancy and reduce the incidence rate of birth defects. Methods： Thirty - six pregnant women undergoing selective preg- nancy reduction of multiple pregnancy in the hospital from 2003 to 2013 were selected; selective pregnancy reduction operation was performed in early pregnancy by direct suction or suction combined with 10% potassium chloride injection into fetal body under ultrasound guidance ac- cording to the size of embryo; transabdominal selective pregnancy reduction operation was performed in middle and late pregnancy by heart cavity injection of 10% potassium chloride under ultrasound guidance. The prognosis of pregnant women was analyzed. Results： Among 36 pregnant women, 22 late pregnant women, 11 middle pregnant women and 3 late pregnant women were included, selective pregnancy reduc- tion operation was completed successfully for the first time, no complication was found, the successful rate was 100. 00%. A total of 37 neo- nates were born, 13 neonates were single pregnancy and 12 neonates were twin pregnancy. Conclusion： Selective pregnancy reduction of multiple pregnancy is a safe and effective intrauterine treatment, conducting selective pregnancy reduction after ultrasonic screening during pregnancy can improve the successful rate of pregnancy and prevent the birth of neonates with birth defects.