阴道超声引导下多胎妊娠减胎术52例临床分析

目的探讨阴道超声引导下选择性减胎术在多胎妊娠中的临床应用。 方法回顾性分析2013年1月至2018年12月在徐州市中心医院生殖中心就诊的10周以内的多胎妊娠患者52例，行阴道超声引导下选择性减胎术，术后分为减胎单胎组（16例）和减胎多胎组（36例）。另外随机选取同期因不孕症来本中心就诊，经治疗后妊娠的10周以内的单胎和双胎患者共82例作为对照组，分别为对照单胎组（45例）和对照双胎组（37例）。统计其胎儿出生体质量、低体质量出生率、早产率、晚期流产率以及孕期的相关并发症，包括妊娠期糖尿病、妊娠期高血压、产后出血以及胎膜早破发生率。采用独立样本的t检验比较4组患者胎儿出生体质量的差异，采用χ²检验比较4组患者的胎儿低体质量出生率、早产率和晚期流产率以及孕期的相关并发症发生率的组间差异。 结果52例多胎妊娠减胎成功率为100%，减胎双胎组早期自然流产1例，晚期自然流产4例。减胎双胎组胎儿出生体质量低于减胎单胎组［（2.52±0.48）kg vs（3.41±0.31）kg，t=2.495，P=0.023］，而胎儿低体质量发生率高于减胎单胎组（35.5% vs 6.3%，χ²=3.916，P=0.048），晚期流产率（25.7%）以及早产率（33.3%）均高于减胎单胎组（P=0.043、0.013），减胎单胎组晚期流产率以及早产率均为0，组间差异均具有统计学意义。与对照组相比，减胎单胎组与对照单胎组、减胎双胎组与对照双胎组胎儿出生体质量、低体质量发生率、晚期流产率以及早产率比较，差异均无统计学意义（P均>0.05）。减胎双胎组妊娠期高血压、妊娠期糖尿病以及产后出血与减胎单胎组比较，差异均无统计学意义（P均>0.05），但胎膜早破发生率高于减胎单胎组（45.2% vs 6.3%），差异具有统计学意义（χ²=5.672，P=0.017）。 结论阴道超声引导下选择性减胎术能改善多胎妊娠的妊娠结局，是一项安全、有效的临床技术。

Clinical analysis of 52 cases of vaginal ultrasound-guided fetal reduction of multiple pregnancies

ObjectiveTo explore the clinical application of selective fetal reduction guided by transvaginal ultrasound in multiple pregnancies. MethodsA retrospective analysis was performed on 52 cases of multiple pregnancies within 10 weeks from January 2013 to December 2018 at the Reproduction Medical Center of our hospital. All patients underwent selective reduction under the guidance of transvaginal ultrasound. After operation, they were divided into either a single-fetus group or a multiple-fetus group. In addition, 82 cases of single and twin pregnancies within 10 weeks after treatment were randomly selected as a single-fetus control group and multiple-fetus control group, respectively. Fetal birth weight, low birth weight rate, premature birth rate, and late abortion rate, as well as the related complications during pregnancy, including gestational diabetes mellitus, gestational hypertension, postpartum hemorrhage, and premature rupture of membranes, were recorded. The four groups of subjects were compared for the above indicators. ResultsThe successful rate of fetal reduction in the 52 cases of multiple pregnancies was 100%. In the twin pregnancy group after fetal reduction, there was one case of early spontaneous abortion and four cases of late spontaneous abortion. The incidence of fetal birth weight in the multiple-fetus group was significantly lower than that in the single-fetus group (2.52±0.48) kg vs (3.41±0.31) kg, t=2.495, P<0.05], while the low birth weight rate was significantly higher than that in the single-fetus group (35.5% vs 6.3%, χ²=3.916, P<0.05). The late abortion rate and premature delivery rate in the multiple-fetus group were significantly higher than those in the single-fetus group (25.7% vs 0; 33.3% vs 0, P=0.043、0.013). Both the single-fetus group and multiple-fetus group had similar birth weight, low birth weight, late abortion rate, and premature delivery rate compared with their respective control groups (P>0.05). There was no difference between the single-fetus group and multiple-fetus group in pregnancy hypertension, gestational diabetes mellitus, or postpartum hemorrhage (P>0.05), but the incidence of premature rupture of membranes was significantly higher in the multiple-fetus group than in the single-fetus group (45.2% vs 6.3%, χ²=5.672, P=0.017). ConclusionVaginal ultrasound-guided selective fetal reduction can significantly improve the pregnancy outcome of multiple pregnancies, representing a safe and effective clinical procedure.