伴有单卵双胎的三胎妊娠经阴道减胎术后的妊娠结局分析

Analysis of Pregnancy Outcomes after Transvaginal Reduction of Triple Pregnancies with Monozygotic Twins

目的:探讨伴有单卵双胎(MZT)的三胎妊娠行减胎术后的妊娠结局。方法:回顾性分析2009年1月-2018年12月南京市妇幼保健院生殖中心收治的47例伴有MZT与45例非MZT的三胎妊娠孕妇行经阴道减胎术后的活产率、足月产率、早产率、早期流产率、晚期流产率、单胎活产率、双胎活产率、分娩孕周、新生儿出生体质量发生率和低出生体质量发生率。结果:(1)与非MZT三胎妊娠组相比,伴有MZT三胎妊娠组减胎术后的早产率、双胎活产率低于前者,单胎活产率、分娩孕周高于前者,差异均有统计学意义(P<0.05)。(2)在47例伴有MZT的三胎中,16例行单卵单胎减胎术,31例行单卵双胎中一胎减胎术。与行单卵单胎减胎术相比,行单卵双胎中一胎减胎术者单胎活产率、新生儿体质量高于前者,但双胎活产率、低体质量儿发生率低于前者,差异均有统计学意义(P<0.05)。结论:对于伴有MZT的三胎妊娠孕妇行经阴道减灭单卵双胎中一胎是可行的,更易获得单胎妊娠结局。

Objective:To explore the pregnancy outcomes after the reduction of triple pregnancies with monozygotic twins(MZT).Methods:A total of 47 cases of transvaginal reduction due to monozygotic(MZ)-triplets and 45 cases of transvaginal reduction due to non-MZ triplets in our Reproductive Center from January 2009 to December 2018 were retrospectively analyzed.The live birth rate,term birth rate,premature birth rate,early abortion rate,late abortion rate,the rate of the survival of one baby,the rate of the survival of two babies,gestational week of birth,neonatal birth weight and the incidence of low birth weight were compared between the two groups.Results:(1)The rate of premature birth and the rate of survival of two babies were decreased in the MZ-triplet group when compared with the non-MZ triplet group,and the rate of survival of one baby was increased(all P<0.05).(2)In 47 cases of MZ-triplet group,16 cases were performed the embryonic reduction of single-egg single-embryo,and 31 cases were performed the embryonic reduction of one of MZ-twins embryos.Compared with 16 cases of the embryonic reduction of single-egg single-embryo,the rate of the survival of one baby and neonatal birth weight in 31 cases of the embryonic reduction of one embryo MZ-twins embryos were increased,while the incidences of the survival of two babies and low birth weight infant were decreased(all P<0.05).Conclusions:Transvaginal reduction of one of MZ-twins embryos in those triple-pregnancies with MZT is feasible and easier to obtain the outcome of single pregnancy.