6例双绒双胎妊娠中期选择性减胎后胎膜早破患者妊娠结局分析

目的：回顾性分析通过辅助生殖技术受孕的双绒毛膜双羊膜囊双胎（双绒双羊双胎）妊娠中期减胎后发生胎膜早破患者的妊娠结局，为临床妊娠中期胎膜早破患者的治疗提供一定的临床依据。方法：收集2012年1月—2018年2月在武汉大学人民医院生殖中心选择性减胎后发生胎膜早破的双绒双羊双胎妊娠患者6例，患者受孕方式为体外受精（IVF）或胞浆内单精子注射（ICSI），绒毛膜性在妊娠早期超声诊断为双绒双羊双胎，孕12～16周接受选择性减胎。结果：6例患者均减胎成功，减灭的胎儿除了1例为右侧胎儿，1例为左下方胎儿，其余4例均为下方胎儿。减胎后胎膜早破均发生在减胎后的24 h内，所有患者均在减胎胎膜早破后8 d之内（2～8 d）停止阴道流液。整个妊娠期1例患者妊娠晚期羊水过少，1例因胎膜早破早产，1例合并妊娠期糖尿病，另3例患者无异常。除了胎膜早破早产患者分娩孕周为34+6周，其余均为足月分娩，其中有4例患者剖宫产，2例经阴道顺产。新生儿体质量为2 200～3 400 g，4名男婴，2名女婴，除早产儿合并肺部感染外，其余新生儿均无并发症。结论：辅助生殖技术受孕双绒双胎妊娠中期选择性减胎后胎膜早破患者可以建议期待治疗，其妊娠结局可能是令人满意的，然而仍需要大样本研究来证实。

Pregnancy Outcomes in Six Patients with Dichorionic Twins and Premature Rupture of Membranes Following Selective Fetal Reduction During Early Midterm

Objective：To study the pregnancy outcome after selective fetal reduction in bichorionic twin pregnancies complicated by extremely preterm premature rupture of membranes in one sac, its main purpose is to provide some clinical data for the treatment of patients with very early premature rupture of membranes. Methods: This is a retrospective study of 6 patients who underwent selective fetal reduction for multiple gestations at the Reproductive Center of Renmin Hospital of Wuhan University from January 2012 to February 2018. All patients were conceived by IVF or ICSI. Results: Selective fetal reduction was performed successfully in 6 cases. One of six abnormal fetuses was the right one, one case was the left and the rest was lower fetus. The fluid breakage occurred within 24 hours and stopped within 8 days after fetal reduction. One women had oligohydramnios in the third trimester, one patient occurred premature rupture of premature rupture of membranes, and one patient had gestational diabetes mellitus during pregnancy. Of the 6 patients who underwent selective fetal reduction, one had preterm labor at 34+6 gestation weeks, while the other 5 were full-term delivery, of which 4 patients had cesarean section and 2 patients had vaginal birth. The six neonatal weight was 2 200-3 400 g, 4 were male infants, while 2 were female. Except for premature infants with lung infection, the other newborns had no complications. Conclusions: It recommends to expectant treatment for patients of dichorionic twins complicated by extremely preterm premature rupture of membranes of one sac performed selective fetal reduction. However, large sample studies are still needed to confirm this conclusion.