全面二孩政策下多胎妊娠减胎术55例临床结局分析

Clinical analysis of 55 cases of multifetal pregnancy reduction under the two-child policy

目的分析全面二孩政策以来,我中心行辅助生殖技术(assisted reproductive technology,ART)治疗后获多胎临床妊娠并实行超声引导下减胎术的55例患者的临床结局。方法回顾性分析2016年1月至2018年6月在南方医科大学南方医院生殖医学中心经ART治疗后获得多胎临床妊娠并行经阴道多胎妊娠减胎术的55例患者,并分析实行减胎术的原因及术后的妊娠结局,比较多胎减至双胎和多胎减至单胎及一胎组和二胎组的流产率、早产率、低体重儿率等指标。结果在55例减胎患者中,高龄且合并瘢痕子宫占74.36%,早期流产率为0.00%,晚期流产率为13.33%,早产率为20.51%,低体重儿率为15.22%。多胎减至双胎的早产率和低体重儿率明显高于多胎减至单胎组。一胎组的早产率和低体重儿率高于二胎组,平均年龄、平均孕周、平均胎儿出生体质量均低于二胎组。结论对于高龄合并瘢痕子宫的患者提倡单胚胎移植,多胎妊娠应减为单胎。

Objective To analyze the clinical outcomes of 55 patients who got multifetal pregnancy and undergo ultrasound-guided reduction.Methods A retrospective was performed in 55 cases with multifetal pregnancy after treatment with assisted reproductive technology at the Center for Reproductive Medicine of Nanfang Hospital of Southern Medical University from January 2016 to June 2018.We analyzed the causes and postoperative pregnancy outcomes and compared the abortion rate,premature birth rate,low birth weight rate and other indicators between multifetal pregnancy to twin pregnancy and multifetal pregnancy to singleton pregnancy,so did between the first child group and the second child group.Results Among the 55 patients with fetal reduction,the advanced age combined scarred uterus accounted for 74.36%,the early abortion rate was 0.00%,the late abortion rate was 13.33%,the preterm birth rate was 20.51%,and the low birth weight rate was 15.22%.The preterm and low birth rate of multifetal pregnancy to twin pregnancy was significantly higher than that of multifetal pregnancy to singleton pregnancy.The preterm and low birth weight rates of the first child group were higher than those of the second child group.The mean age,average gestational age,and average fetal birth weight were lower than the second child group.Conclusions For patients with advanced age and scarred uterus,it is strongly recommended to transplant a single blastocyst for the purpose of obtaining a singleton pregnancy.It is necessary that multifetal pregnancy must be reduced to single pregnancy.