多胎妊娠患者124例减胎术后妊娠结局的分析

Analysis of Pregnancy Outcomes in 124 Cases of Polycyesis after Fetal Reduction Surgery

目的分析多胎妊娠患者减胎术后的妊娠结局。方法收集2016年10月至2018年10月山西医科大学第一医院行多胎妊娠减胎术的124例多胎妊娠患者的临床资料,分析减胎时间、保留胎儿数等因素与妊娠结局的关系。结果①经阴道减胎患者中,保留单胎组与保留双胎组的流产率、活产率、分娩孕周比较差异无统计学意义(P>0.05),保留单胎组新生儿体重高于保留双胎组[(2842±473)g比(2420±464)g](P<0.01);②保留单胎患者中,经阴道减胎组与经腹部减胎组的流产率、活产率比较差异无统计学意义(P>0.05),经阴道减胎组分娩孕周及新生儿体重高于经腹部减胎组[(35.6±8.0)周比(30.4±9.4)周,(2842±473)g比(2446±578)g](P<0.05);③保留单胎组与保留双胎组患者甲状腺功能异常、贫血、前置胎盘、病毒性肝炎、外阴阴道假丝酵母菌病、胎膜早破、妊娠期糖尿病、胎盘早剥发生率比较差异均无统计学意义(P>0.05),保留单胎组妊娠期高血压的发生率低于保留双胎组[3.3%(2/60)比26.6%(17/64)](P<0.01)。结论多胎妊娠患者减胎时,经阴道途径减至单胎可延长分娩孕周,增加新生儿出生体重,并可降低母体妊娠期并发症发生率,改善临床妊娠结局。

Objective To analyze the pregnancy outcomes in 124 patients with polycyesis after fetus reduction surgery.Methods A total of 124 cases of polycyesis admitted to the First Hospital of Shanxi Medical University from Oct.2016 to Oct.2018 were included in the study.The relationship between factors such as the time of fetus reduction and the number of fetuses retained and the pregnancy outcome was analyzed.Results①There was no significant difference in abortion rate,live birth rate and gestational age between the single-fetus retained group and the twin retained group in the patients with transvaginal reduction(P>0.05).The birth weight of the newborn of the single-fetus retained was significantly higher than that of the twin retained group[(2842±473)g vs(2420±464)g](P<0.01).②There was no significant difference in abortion rate and live birth rate between the vaginal reduction group and the transabdominal group(P>0.05),the gestational age and neonatal weight of the vaginal reduction group were significantly higher than those of the transabdominal group[(35.6±8.0)weeks vs(30.4±9.4)weeks,(2842±473)g vs(2446±578)g](P<0.05).③The thyroid dysfunction,pregnancy with anemia,placenta previa,pregnancy with viral hepatitis,pregnancy with vulvovaginal candidiasis,premature rupture of membranes,gestational diabetes,placental abruption of the single-fetus retained group and twin retained group had no statistically significant differences(P>0.05),the incidence of hypertensive disorder in pregnancy of the single-fetus retained group was lower than that in the twin retained group[3.3%(2/60)vs 26.6%(17/64)](P<0.01).Conclusion In patients with polycyesis,the reduction to singleton can prolong the perinatal gestational age,increase the birth weight,reduce maternal pregnancy complications,and improve clinical pregnancy outcomes.