173例多胎妊娠选择性减胎术后的围生结局

目的:分析多胎妊娠选择性减胎术后的围生结局。方法:回顾性分析2012年1月至2015年9月间173例多胎妊娠孕妇在广州医科大学附属第三医院胎儿医学中心通过经腹胎儿心内注射氯化钾(KCL)减胎术或射频消融(RFA)减胎术将多胎妊娠减至单胎或双胎的临床资料,分析减胎术后的围生结局。结果:KCL减胎术121例,术后流产率为10.0%,围生儿存活率89.2%。孕早期的流产率、≤34周早产率与孕中期比较,差异无统计学意义(P0.05);保留单胎的分娩孕周较保留双胎的延长约2周(37.96±2.65周vs 35.93±2.19周)且新生儿体质量更重(2.91±0.55 kg vs 2.51±0.44kg),差异有统计学意义(P0.05)。RFA减胎术52例,术后围生儿存活率为71.2%。双胎输血综合征(TTTS)、选择性胎儿生长受限(s FGR)、双胎反向灌注序列综合征(TRAPs)、双胎之一结构或遗传异常术后的存活率分别为68.2%、83.3%、100.0%、53.8%。结论:KCL减胎术可在孕早中期进行,减至单胎可能更有益于围生结局。RFA减胎术中s FGR和TRAPs术后的存活率较高。选择性减胎术对改善多胎妊娠的围生结局有益。

Selective Fetal Reduction in Multiple Pregnancies:173 Cases in One Center

Objective:To evaluate the perinatal outcome of multiple pregnancies after selective fetal reduction.Methods:173 cases of multiple pregnancies were performed selective reduction with transabdominal injection of potassium chloride(KCL) into fetal heart or radiofrequency ablation(RFA) in one single institution during January 2012 to September 2015.The clinical data was collected to review the perinatal outcome.Results:Transabdominal of KCL reduction was performed in 121 cases,the miscarriage rate was 10.0％ (11/110),while the survival rate was 89.2％.The miscarriage rate and ≤34 week preterm birth rate in the first trimester and the second trimester were no statistically significant differences(P ＞ 0.05).For reduction to singletons vs twins,the mean gestational age at delivery was 2 weeks longer in singletons (37.96 ± 2.65 vs 35.93 ± 2.19),and neonatal birth weights also greater(2.91 ±0.55 vs 2.51 ±0.44) (P＜0.05).Fifty-two cases of multiple pregnancies were performed RFA and the survival rate was 71.2％.Indications as TTTS,sFGR,TRAPs and structural or genetic abnormalities have different survival rate,which was 68.2％,83.3％,100.0％ and 53.8％,respectively.Conclusions:Transabdominal of KCL reduction can be performed in the first and second trimester,and the perinatal outcome seems more beneficial when reduced to singletons.The survival rate of sFGR and TRAPs was higher than other indications in RFA.Selective fetal reduction is beneficial for improving the prenatal outcome of multiple pregnancies.