辅助生殖技术助孕后的多胎妊娠早孕期减胎91例分析

Analysis of transvaginal ultrasound-guided multifetal pregnancy reduction in 91 cases after assisted reproduction

目的:评价辅助生殖技术(ART)助孕后多胎妊娠早孕期减胎术的安全性及必要性。方法:回顾性分析91例多胎妊娠B超引导下经阴道选择性减胎患者的临床资料,统计其早期流产率、晚期流产率,并将减胎后的患者分为单胎妊娠组及双胎妊娠组,统计各组早产率、早产孕周、早产平均体质量及足月低体质量儿出生率,并与同期施行ART助孕的单胎妊娠及未行减胎的双胎妊娠4 623例进行比较分析。结果:减胎组早期流产率为2.20%,明显优于同期妊娠的早期流产率(10.96%),组间有统计学差异。减胎后的单胎妊娠组早产率、早期流产率及晚期流产率均优于未行减胎的双胎妊娠组。结论:早孕期施行B超引导下经阴道选择性减胎术是安全的,且可有效减少多胎妊娠发生,改善其不良妊娠结局。

Objective： To evaluate the safety and necessity of fetal reduction for multiple pregnancies during the period of early pregnancy after assisted reproductive technology （ART） treatments. Methods： This study was a retrospective analysis of the clinical data of 91 patients who received selective fetal reduction by transvaginal ultrasound-guide. Main outcomes such as premature gestational age, early and late abortion rates were compared. The patients were divided into single-pregnancy group and twin-pregnancy group. The preterm rate, the preterm gestational age, preterm and full-term average weight of low birth weight children were compared between the two groups. These parameters were also compared with the 4 623 cases of the single-pregnancy patients and the two-pregnancy patients who did not select fetal reduction during the same time. Results： The early abortion rate was significantly lower in fetal reduction group than that in the pregnant group with the same time （2.20% vs 10.96%）. Compared with the twin pregnancy patients who did not select fetal reduction, the preterm rate, the early abortion rate and the late abortion rate were significantly lower in single pregnancy patients who selected fetal reduction. Conclusion： Selective fetal reduction surgery by transvaginal ultrasound-guide is safe and effective in reducing the incidence of multiple pregnancies during the period of early pregnancy, most of all, it also can improve its adverse pregnancy outcomes.