双绒毛膜双羊膜囊一胎畸形孕中晚期经腹选择性减胎12例临床分析

Clinical analysis of 12 cases of selective transabdominal reduction in the second and third trimester of twin pregnancy with single malformation

目的探讨双绒毛膜双羊膜囊双胎妊娠一胎畸形在孕中晚期实施经腹选择性药物减胎术的临床特点、减胎时机、安全性及妊娠结局。方法回顾性分析2017年5月至2019年3月华中科技大学同济医学院附属同济医院产科收治的12例双胎妊娠一胎畸形经腹选择性减胎孕妇的临床资料。结果所有接受选择性减胎术的孕妇绒毛膜性均为双绒毛膜双羊膜囊,减胎时平均孕周为(24.68±3.22)周。受孕方式为自然受孕6例,体外受精-胚胎移植辅助生殖技术5例,使用促排卵药物1例。减胎指征:系统胎儿超声筛查提示一胎儿严重畸形者9例,产前诊断提示一胎儿染色体异常者5例。减胎方式均采取B超引导下经腹胎儿心脏或脐静脉内注射10%氯化钾溶液,减胎成功率为100%,未见感染、流产、死胎等并发症。妊娠结局:4例发生早产,8例足月分娩,新生儿Apgar评分均在7分以上。结论对双绒毛膜双羊膜囊的双胎妊娠一胎畸形的孕妇于孕中晚期实施经腹选择性药物减胎术是安全可行的,但对操作人员的技术有较高要求,尽早实施减胎术有利于成功减除畸形胎儿、得到良好的妊娠结局,对家庭及社会都有重要意义。

Objective To investigate the clinical characteristics,timing,safety and outcome of selective transabdominal reduction of twin pregnancy with single malformation in the middle and late pregnancy.Methods A retrospective analysis was performed on the clinical data of 12 pregnant women with twin pregnancy and one fetus deformity who underwent selective transabdominal reduction from May 2017 to March 2019 in the Obstetrics Department of Tongji Hospital,Tongji Medical College Huazhong University of Science and Technology.Results The chorionic amniotic sacs of all the pregnant women was double chorionic and double amniotic sacs,and the mean gestational week was(24.68±3.22)weeks when taking transabdominal multifetal reduction.There were 6 cases of natural conception,5 cases of IVF-ET assisted reproductive technology,and 1 case of ovulation promoting drugs.Reduction indication:systematic fetal ultrasound screening suggested one fetal malformation in 9 cases,prenatal diagnosis suggested one fetal chromosome abnormality in 5 cases.Potassium chloride was injected into the fetal heart or umbilical vein under the guidance of ultrasound,and the success rate of reduction was 100%.No infection,abortion or stillbirth was observed,4 cases of premature birth,8 cases of term birth.The Apgar score of newborns were all above 7.Conclusion It is safe and feasible to carry out selective transabdominal reduction in the second and third trimester for the pregnant women of twin pregnancy with one deformity,but it requires high technical requirements for the operators.Successful reduction of the deformities is conducive to a better pregnancy outcome,which is also of great significance to the family and society.