多胎妊娠选择性减胎术方法和妊娠结局

The pregnancy outcomes and methods of multiple pregnancy selective reduction

目的比较妊娠早期与妊娠中期行氯化钾选择性减胎术的并发症、妊娠结局、分娩孕周和新生儿出生体重情况。方法回顾性分析2013年1月至2015年5月在本院就诊,确诊为多胎妊娠并行氯化钾选择性减胎术的81例病例。根据超声标记行氯化钾选择性减胎术,统计减胎术后流产、早产等并发症及新生儿结局。结果减胎成功率100%,误减率0;早期与中期妊娠减胎术后均无出血、羊水溢漏、术后早期流产、凝血障碍等并发症。81例已知妊娠结局中,早期、中期二者术后晚期流产率分别为9.09%和12.50%,无统计学差异;新生儿平均出生体重分别为(2.73±0.59)kg和(2.57±0.54)kg;分娩孕周分别为(263.70±17.18)天和(256.79±14.19)天,无统计学差异。结论中孕期、早孕期发生早产率及分娩率无明显差异;早、中孕期流产率无明显差异。中期妊娠减胎术与早期妊娠减胎术一样可作为避免多胎妊娠出生的一种有效手段,中期妊娠减胎术也是一种避免异常胎儿出生的安全、简便、有效方法。减胎术前应准确识别超声减胎标记,确认被减胎儿,避免误减正常胎。

Objective To compare the operation complications, pregnancy outcomes, gestational age and newborn child birth weight after the first and second-trimester fetal of multiple pregnancies. Method 81 patients were retrospectively collected from January, 2013 to May, 2015. The patients who confirmed that multiple pregnancies and performed fetal reduction with potassium chloride. The multifetal pregnancy reduction by the ultrasound-guided technique, we compared with operation complications and newborn child outcome. Results The success rate of 100% and the failure rate of 0%. There was no bleeding, amniotic fluid leakage, postoperative early abortion, coagulation disorder and other complications after the first and second-trimester fetal reduction of multiple pregnancies. After the two reduction operation of multiple pregnancies, the late abortion were 9. 09% and 12. 50%, no significant difference, the average birth weight of newborn was（2.73±0.59）kg and（2.57±0.54）kg, the gestational age was （263.70±17.18） days and （256.79±14.19）days, no significant difference. Conclusions The rate of preterm labor , birth and abortion ,there was no significant difference between the first and second trimesters. The second-trimester fetal reduction of multiple pregnancies could be used as an effective means to avoid multiple pregnancy birth as the first trimester fetal reduction of multiple pregnancies and could be used as a safe, simple and effective method to avoid the birth of abnormal fetus. Before reduction, we should accurately identify ultrasound marker, confirming that the reduced fetal and avoid misuse normal fetal reduction.