多胎妊娠经阴道胚芽抽吸法减胎术围生结局分析

The perinatal outcome of transvaginal embryo aspiration reduction for multifetal pregnancy reduction

目的探讨多胎妊娠早孕期经阴道行胚芽抽吸法减胎术的围生结局。方法对2008年1月至2018年12月于广州医科大学附属第三医院就诊并行经阴道减胎术的161例患者进行回顾性分析,分析不同减胎前个数、减胎个数、减胎后剩余胚胎个数的流产率、早产率、分娩孕周、剖宫产率、新生儿出生体重、身长、低体重出生儿、极低体重出生儿等围生结局。结果早孕期经阴道胚芽抽吸减胎术的流产率、早产率、抱婴回家率、剖宫产率、低体重儿及极低体重儿发生率分别为13%、29.8%、87%、65.7%、41.1%与7.0%,平均分娩孕周、体质量、身长分别为(36.85±2.216)周、(2 538.34±575.58)g、(46.76±3.46)cm。减胎前个数越多,低体重儿及极低体重儿发生率越高,差异均有统计学意义(P <0.05);与减胎个数为1个相比,≥2个者的分娩孕周增大(OR=0.97,95%CI:0.69~1.36,P <0.0001),剖宫产率增高,差异均有统计学意义(P <0.05);与剩余单胎相比,双胎的分娩孕周更小(OR=1.056,95%CI:0.77~1.44,P <0.0001),围生结局更差,差异均具有统计学意义(P <0.05)。结论孕早期多胎妊娠行胚芽抽吸减胎技术是安全有效的;起始胚胎个数少,减胎个数多,剩余胚胎个数少的新生儿围生结局较好。

Objective The aim of this study is to investigate the perinatal outcome of fetal reduction bytransvaginal embryo aspiration reduction during early pregnancy. Methods We retrospectively analyzed 161 patientswho had undergone transvaginal embryos reduction in the Third Affiliated Hospital of Guangzhou Medical Universityfrom January 2008 to December 2018. The different perinatal outcomes of starting number,reduction number andremaining number of embryos were compared respectively,including the rate of abortion,premature birth,lowbirth weight infant,very low birth weight infant and cesarean section,the delivery weeks,the birth weight andbody length of the newborns. Results The rate of the abortion,the premature delivery,the take home rate andcesarean section was 13%,29.8%,87% and 65.7% respectively. The average gestational age,delivery weight andbirth length were(36.85 ± 2.216)weeks,(2 538.34 ± 575.58)g,(46.76 ±3.46)cm respectively. The rate of lowbirth weight and very low birth weight was 41.1%,and 7.0%. With higher starting number,there were higher rateof low weight and very low weight newborns(P < 0.05). Compared with one embryos reduced group,there were big-ger gestational age(OR = 0.97,95% CI:0.69 ~ 1.36,P < 0.000 1)and lower rate of cesarean section in the groupwith more than two embryo reduced(P < 0.05). Compared with remaining single embryo,the perinatal outcome ofthe remaining twins was worse(P < 0.05),and the gestational age was smaller(OR = 1.056,95% CI:0.77 ~ 1.44,P < 0.000 1). Conclusion The technique of transvaginal embryo aspiration reduction in multiple pregnancy duringearly pregnancy is safe and effective. The pregnant women with fewer initial embryos,more embryos reduced andless remaining embryos has a better perinatal outcome.