三胎妊娠减灭成双胎妊娠的妊娠结局分析

Multifetal pregnancy reduction of triplets to twins: a prospective comparison of pregnancy outcome

目的 探讨三胎妊娠行减胎术的妊娠结局以及三胎妊娠是否需行减胎术。方法 收集在浙江大学医学院附属妇产科医院和邵逸夫医院妇产科经排卵诱导和辅助生殖技术受孕的以及在这两家医院分娩的三胎妊娠 ,共 6 0例 ,其中 2 8例未行减胎术 ,32例实施减胎术。 6 0例均采用经阴道B超引导下穿刺和物理创伤使心跳停止行减胎术。比较两组的母亲产科并发症发生率、早产率、分娩时平均孕周、新生儿出生体重和出生 <15 0 0g新生儿的比例。结果 母亲产科并发症发生率和早产率在行减胎术组显著低于未行减胎术组 ;分娩时平均孕周在行减胎术组略高于未行减胎术组 ;平均新生儿出生体重在行减胎术组显著高于未行减胎术组 ,其中 <15 0 0g的新生儿比例在行减胎术组中明显降低。结论 对三胎妊娠行减胎术可以改善妊娠结局。在辅助生殖技术治疗过程中 ,应尽量避免多胎妊娠的发生 ;一旦发生多胎妊娠 ,只要孕妇及其家属愿意 ,应行减胎术。

Objective To investigate the outcome of triplet pregnancy and the necessity and benefit of multifetal pregnancy reduction (MFPR). Methods Sixty cases of triplet pregnancy were collected. In 15 cases that did not choose MFPR, the triplets were spontaneously obtained. Out of the 45 cases with triplets obtained after infertility treatment, 32 chose reduction to obtain twins using transvaginal puncture of the fetal heart and physical hurt. The maternal obstetric complication rate, preterm delivery rate, means gestational age at delivery, birth weight of infants and percentage of fetal weights <1 500 g were compared between these two groups. Results The maternal obstetric complication rate and preterm delivery rate were lower significantly in the reduction group. Deliveries occurred earlier slightly in the triplets group compared with the reduction group. The mean birth weight of infants was higher and the percentage of low weight infants (<1 500 g) was lower in the reduction group. Conclusion MFPR of triplets to twins is effective to improve pregnancy outcome. MFPR applied on triplets is reasonable and should be accepted if requested.