不同绒毛膜性质三胎妊娠减一胎的临床结局

Clinical outcomes of multifetal pregnancy reduction in triplet pregnancy with different chorionic properties

目的分析不同绒毛膜性质三胎妊娠减灭一胎的有效性和可行性。方法回顾性分析33例经辅助生殖技术治疗获三胎妊娠,且孕6~10周行经阴道减胎术患者,其中14例双绒毛膜三羊膜囊(dichorionic-triamniotic,DCTA)三胎妊娠为DCTA组,19例三绒毛膜三羊膜囊(trichorionic-triamniotic,TCTA)三胎妊娠为TCTA组。通过病例资料匹配选择同期获双绒毛膜双羊膜囊(dichorionic-diamniotic,DCDA)双胎妊娠且未行减胎术的患者60例作为DCDA组。比较三组患者的临床妊娠结局、妊娠期并发症和新生儿情况。结果所有减胎患者术中均保留双胎,无减胎失败病例。减胎术后1 d,DCTA组有10例(71.4%)出现单绒毛膜双羊膜囊(monochorionic-diamniotic,MCDA)保留胎儿自然减灭,TCTA组无自然减胎,差异有统计学意义(P<0.05)。术后1周至孕晚期,三组自然减胎和自然流产的发生率差异均无统计学意义(P>0.05)。DCTA组单胎活产率(75%)及平均分娩孕周[(38.3±2.2)周],均显著高于TCTA组[5.3%,(36.6±1.7)周]和DCDA组[17.5%,(37.1±1.7)周,P<0.05]。结论孕早期三胎妊娠行减胎术减灭一胎安全可行。DCTA三胎妊娠减灭其中MCDA双胎之一,另一保留胚胎发生自然减胎几率增加。故需充分告知减胎术,尤其是减灭其中MCDA双胎之一的相关风险。

Objective To analyze the effectiveness and feasibility of selective multifetal pregnancy reduction(MFPR)in triplet pregnancy with different chorionic properties.Methods A total of 33 patients obtaining triplet pregnancy with different chorionic properties by assisted reproductive technology and undergoing selective MFPR in the Department of Reproductive Medicine,Guangdong Provincial Fertility Hospital were retrospectively analyzed,including 14 dichorionic-triamniotic(DCTA)triplet pregnancies and 19 trichorionic-triamniotic(TCTA)triplet pregnancies.Sixty dichorionic-diamniotic(DCDA)twin pregnancies without MFPR were collected as controls.The pregnancy outcomes,pregnancy complications,and neonatal status were compared among the three groups.Results All thepatients undergoing selective MFPR were successful to have DCDA twin pregnancy after the procedure.Spontaneous pregnancy reduction occurred in 10 DCTA triplet pregnancies(10/14,71.4%)but not in TCTA anytriplet pregnancy(0/19,0.0%)one day aftertheprocedure.The difference between the two groups was statistically significant(P<0.05).There were no significant differences in the rates of spontaneous pregnancy reduction and spontaneous abortion among three groups(P>0.05).The singleton live birth rate and gestational weekat delivery were significantly higher in the DCTA triplet pregnancy group[75%,(38.3±2.2)weeks]than in the TCTA triplet pregnancy and DCDA twin pregnancy groups[5.3%,(36.6±1.7)weeks;17.5%,(37.1±1.7)weeks)](P<0.05).Conclusions Selective MFPR for patients with DCTA or TCTA triplet pregnancy is safeand feasible.Reduction of one MCDA fetal in patients with DCTA triplet pregnancy might significantly increase spontaneous pregnancy reduction rateinthe other MCDA fetal.The patients with triplet pregnancy should be fully informed the relevantrisk of MFPR,especially those with DCTA triplet pregnancy undergoing reduction of one MCDA fetal.