经阴道途径与经腹部途径体外受精-胚胎移植多胎妊娠减胎术后妊娠结局的分析

Comparison of the outcomes between transvaginal and abdorminal multifetal reduction achieved by in vitro fertilization-embryo transfer

目的比较体外受精-胚胎移植(IVF-ET)多胎妊娠在早孕早期(6~8孕周)经阴道减胎与早孕晚期(11~13+6孕周)经腹部减胎术后的妊娠结局,探讨多胎妊娠合适的减胎时机。方法 2014年1月—2016年12月期间于本院经超声波诊断的多胎妊娠拟行减胎手术患者,6~8孕周经阴道减胎组110例,11~13孕周经腹部减胎组78例,比较两组间早产率、流产率、低出生体质量率、胎儿体质量、孕周等。结果比较流产率、低出生体质量率、流产孕周、分娩孕周、平均胎儿体质量组间均无统计学差异。与经腹减胎组(5.13%,6.12%)比较,经阴道减胎组34~37孕周早产率明显升高(17.27%)、减胎个数分层显示6~8孕周双胎减一胎后早产率升高(19.40%)。结论与11~13+6孕周经腹部减胎比较,6~8孕周经阴道减胎组34~37孕周的早产率升高、双胎减一胎后的总体早产率升高。

Objective To investigate the outcomes of fetal reduction for multifetal pregnancies between transvaginal and abdominal approach. Methods Multifetal pregnancies were enrolled from our hospital during Jan. 2014 to Dec. 2016. Totally 110 transvaginal and 78 abdormianl reduciton were included, the rate of abortion, preterm birth, birth weight, birth week were analyzed between the two groups. Results Compared with abdormianl group（5.13%, 6.12%）, transvaginal group had higher preterm rate（17.27%）, higher preterm rate in reduced twins（19.40%）. Conclusion Compared with abdominal group, transvaginal reduction group had higher preterm rate for 34-37 weeks of gestation, especially in reduced tiwns.