经阴道多胎妊娠胚胎减灭术55例临床分析

Analysis of 55 cases of transvaginal multifetal pregnancy reduction

目的 分析在阴道B超引导下对早期高序多胎妊娠进行胚胎减灭术的可行性、安全性及对母儿的影响。方法 对 5 5例经辅助生育技术受孕的早期 (妊娠 49～ 79d)多胎妊娠 ,在阴道B超引导下行胚胎减灭术 ,其中 1例为 7胎妊娠 ,7例为 5胎妊娠 ,16例为 4胎妊娠 ,3 1例为 3胎妊娠。用减胎穿刺针的针尖直刺待减灭胎儿的胎心搏动 (心搏 )处 ,直至原始心搏消失 ,抽吸胚囊内容物 ,或在穿刺胚胎的同时向羊膜囊内注射生理盐水。结果 5 3例 ( 96% )减胎成功 ,其中 49例减为双胎 ,3例 5胎减为 3胎 ,1例 7胎减为 3胎 ;失败 2例 ,均为 4胎妊娠 ,其中 1例为术中流产 ,1例为未减灭。术后流产 8例 (流产率 15 % ) ;早产 2 1例 ,其中 5名早产儿于出生后 1～ 2d内死亡 ,未见畸形 ;足月分娩 2 4例。共出生新生儿 87名 (包括 42名早产儿 ) ,82名新生儿存活 ,除 1名为六指畸形、1名为房间隔缺损外 ,其余新生儿均健康 ,无畸形 ,无脏器损伤、血管损伤大出血及术后感染、发热等。结论 妊娠早期经阴道施行胚胎减灭术是一种定位准确 ,操作简单、易行 。

Objective To report the outcomes of transvaginal ultrasound-guided multifetal pregnancy reduction (MFPR) in early high-order multiple gestation. Methods Fifty-five cases of high-order multiple pregnancy including 1 septuplet, 7 quintuplets, 16 quadruplets and 31 triplets resulted from either superovulation /intrauterine insemination or in vitro fertilization-embryo transfer, were treated by transvaginal ultrasound guided MFPR at 49-79 days of gestational age. Their outcomes and complications were reported. Results Multifetal reduction were successfully done in 53 cases (96%). Miscarriage occurred in 8 patients (15%). Twenty-one cases(47%) were premature delivery and 24 patients underwent term delivery resulting in 87 infants. Five preterm infants died of neonatal respiratory distress syndrome. Among them none has malformation. Of the 82 live infants, 1 had hexadactyly and another arterial septum defect occurred. No organ injury, massive hemorrhage and infection occurred after MFPR. Conclusions MFPR during early pregnancy is a safe, effective, simple operation for the purpose of reducing perinatal and maternal complication.