不同减胎方式对单绒毛膜双羊膜囊双胎临床结局的影响

Effect on Clinical Outcomes by Different Selective Fetal Reduction in Monochorionic Diamniotic Twin Pregnancy

【目的】对比双极脐带电凝减胎术(BCC)与射频消融减胎术(RFA)对单绒毛膜双羊膜囊双胎临床结局的影响。【方法】收集2009-2019年间中山大学附属第一医院行妊娠早期超声检查诊断为单绒毛膜双羊膜囊双胎孕妇53例作为研究对象。所有孕妇孕期均行选择性减胎术,并在我院规律产检及分娩。回顾性分析统计孕妇基本情况、减胎方式的选择、分娩孕周等相关因素对最终的妊娠结局及新生儿结局产生的影响。数据采用SPSS20.0软件进行统计学分析。【结果】RFA组和BCC组术后发生下腹紧缩感的比例分别为65.0%和61.5%,差异无统计学意义,且两组患者经对症处理后下腹紧缩感均可缓解。此外,两组手术时间、住院天数均无统计学差异。RFA组的分娩孕周为366/7(264/7~406/7)周,晚于BCC组的324/7(290/7~374/7)周,但两者差异无统计学意义(P>0.05)。BCC组在妊娠370/7周前分娩的比例高于RFA组(100%vs.62.5%,P=0.024)。新生儿结局中,BCC组的低出生体质量儿率大于RFA组(92.31%vs.52.5%,P=0.025),极低出生体质量儿率的差异则无统计学意义(P>0.05),小于胎龄儿发生率亦无统计学差异(P>0.05)。BCC组的新生儿转到儿科或重症监护进行观察的比例大于RFA组(84.62%vs.30%,P=0.001)。对新生儿结局造成影响的多因素分析发现分娩孕周<270/7周是低出生体质量儿发生的危险因素(OR=2.091,95%CI,0.312~14.162,P=0.032)。【结论】无论是RFA还是BCC,对孕妇的妊娠结局和新生儿结局的影响不同。临床上应综合多方面因素个体化选择减胎方式。

【Objective】To compare clinical outcomes between bipolar umbilical cord coagulation(BCC)and radiofre⁃quency ablation(RFA)after selective fetal reduction in monochorionic diamniotic twin pregnancy.【Methods】We retro⁃spectively analyzed all cases of monochorionic diamniotic twin pregnancies who received selective fetal reduction in The First Affiliated Hospital of Sun Yat-sen University from 2009 to 2019.Patient underwent regular antenatal care during the whole pregnancy and finally delivered in our hospital.The impact of basic conditions of the patients,different methods of reduction,gestational weeks of delivery and other factors on the final pregnancy outcomes and neonatal outcomes were studied.The data were analyzed by SPSS20.0.【Results】The frequency of tightening feeling of the lower abdomen of RFA group and BCC group after surgery were 65.0%and 61.5%,respectively(P>0.05).The symptom was relieved after symptomatic treatment.In addition,time of surgery and the hospitalization days were not statistically different between the two groups.The median gestational age at delivery of the RFA group was 366/7(264/7~406/7)weeks,which was later than 324/7(290/7~374/7)weeks of the BCC group,without statistical significance(P>0.05).The proportion of patients who delivered before 370/7 weeks in the BCC group was higher than that in the RFA group(100%vs.62.5%,P=0.024).In the neonatal outcomes,the rate of low birth weight infants in the BCC group was greater than that in the RFA group(92.31%vs.52.5%,P=0.025),but the differences in the rate of very low birth weight infants and the rate of small for gestational age infant were not statistically significant(both P values are greater than 0.05).The rate of neonatal transfer pediatrics or intensive care unit in the BCC group was greater than that of the RFA group(84.62%vs.30%,P=0.001).In a multivariate analysis of the effects on neonatal outcomes,multivariate logistic regression was used to analyze the association between different indicators and the incidence of low birth weight infants.The results showed that gestational weeks<270/7 weeks was a risk factor for low birth weight infant(OR=2.091,95%CI,0.312 to 14.162,P=0.032).【Conclusions】The effects of RFA and BCC on the pregnancy outcome and neonatal outcome are different.We should consider various factors when we choose individualized method of pregnancy reduction.