60例产前诊断双胎之一异常的减胎术分析

60 cases of selective fetal reduction after prenatal diagnosis with abnormal one in twin pregnancy

目的总结双胎妊娠中有产前诊断指征的病例92例,介入性产前诊断后发现双胎之一异常行减胎术的分析,进一步规范术前准备与术中操作,分析术后并发症,研究双胎产前诊断后再行减胎术的安全性及作用。方法回顾性分析2012年1月至2017年2月,在本院医学遗传中心行产前诊断后双胎之一异常后再行减胎术的双胎病例60例,同期双胎妊娠行产前诊断而无需行减胎术的病例32例,比较两组穿刺术后流产、早产发生率。结果减胎组与非减胎组两组平均产前诊断时间为孕18^(+5)周(11^(+5)~32^(+2)周)与孕21^(+3)周(12^(+2)~29周),减胎的平均孕周中,自然受孕组为孕20^(+3)周(13^(+2)~28周),辅助生育技术组为孕24^(+5)周(13^(+4)~35^(+6)周),术后1个月内流产率分别5.0%(3/60)与6.25%(2/32),无统计学差异;双胎之一异常胎行心腔内注射10%氯化钾溶液减胎术后存活胎早产率是6.67%(4/60),非减胎组的双胎早产率28.1%(9/32),有统计学差异;所有减胎术一次完成,成功率100%。结论双胎妊娠对母体与胎儿都有较高的并发症,对产前诊断后双胎之一异常胎儿行减胎术是安全的操作。二次介入性产前诊断操作不增加流产的风险,同时有效降低双胎早产的风险。

Objective To analyze 92twin-pregnancy cases underwent prenatal diagnosis with invasive indicates,furthermore abnormal fetal reduction were proceed.This study aims to prove the safety of multifetal pregnancy reduction and built the guide of this procedure.Method Totally 60 cases twin-pregnancy with one abnormal fetal were underwent reduction,30 cases of twin-pregnancy without reduction were accepted invasive diagnosis in the same period.The abortion rate and premature delivery rate were compared in these two groups.Results The mean gestational weeks of prenatal diagnosis were in 18^（＋5） weeks（11^（＋5）~32^（＋2） weeks）and 21^（＋3） weeks（12^（＋2）~29 weeks）separately in reduction or non-reduction groups;The mean timing of reduction procedure were in 20^（＋3） weeks gestation and 24^（＋5） weeks separately in naturally conceived twin-pregnancy group and in-vitro fertilization twin-pregnancy group.The abortion rates of these two groups in one month after reduction procedure were 5.0%（3/60）and 6.25%（2/32）,without statistics differences.The premature delivery rates of fetal reduction group（the abnormal fetus were injected 10% potassium chloride intracardiacally）and non-reduction group were 6.67%（4/60）and 28.1%（9/32）respectively,the differences were significantly.The successful ration of reduction was 100% with one puncture.Conclusions Multifetal pregnancy reduction was a safe procedure to decrease the number of fetus with abnormalities;It did not increase the risk of abortion even the second puncture was performed in order to reduce one of the fetus;The incidence of premature delivery was down after selective multifetal pregnancy reduction.