助孕技术后多胎妊娠早期选择性减胎术——附23例分析

目的 :探讨助孕术后多胎妊娠早期选择性减胎术的指征和方法。方法 :( 1 )助孕术后总计 62例3胎或以上多胎妊娠 ( 5 9例 3胎 ,3例 4胎 ) ,对其中符合减胎术者 2 3例进行了减胎术。 ( 2 ) 5 9例 3胎妊娠根据胚胎发育情况分成 2组 ,A组 ( 4 6例 ) 3个胚胎发育均正常 ,B组 ( 1 3例 ) 1个或 2个胚胎生长异常 ;并对此二组测血 β-h CG。 ( 3 ) 2 3例选择性减胎术中 ,9例为机械损伤法 ,1 4例为药物注射法。结果 :( 1 ) β-h CG值 A组为 1 0 0 6.9± 43 2 .3 m IU/m L,B组为 73 3 .8± 41 9.5 m IU/m L。两组有显著差别 ( P=0 .0 3 5 )。( 2 )机械损伤法胚胎丢失率为 3 5 .7% ,明显高于药物注射法 ( 7.1 % )。结论 :( 1 ) β-h CG值 >1 0 0 0 m IU/m L,且胚胎发育正常者是选择性减胎术的指征。( 2 )选择性减胎术时 ,药物注射明显优于机械损伤

Elective Embryo Reduction in Early Stage of Multiple Pregnancy with Assisted Reproduction Technique -Analysis of 23 cases

Objective: To study the effect of elective embryo reduction on pregn ancy outcome in early stage of multiple pregnancy through assisted reproduction technique Methods: Among cases (59 cases were triplet, 3 cases were quadruplet) of multiple pregnancy after in-vitro fertiliza tion, 23 cases were given elective embryo reduction. The triplet cases (59 cases) were divided into 2 groups according to the embryo development. Group A (46 cases) was cases that all the three embryos developed normally. Group B (13 cases) was cases that one or two embryos grew abnormally. β-hCG was deter mined in all the 59 cases. Among the 23 cases with elective embryo reduction, 9 cases were done with mechanical damage method, 14 cases were done with drug met hod. Results: (1) The mean value of first β-hCG in gro up A and group B was 1 006.9 ±432.3 mIU/mL, and 733.8±419.5 mIU/mL respecti vely. The difference between two group was significant (P=0.035). (2) In the 9 cases with mechanical damage method, 5 embryoes were lost in totally 14 embry os, the embryo loss rate was 35.7%, which is significantly higher than that in 1 4 cases with drug method (7.1%). Conclusion: (1) The ind ication for elective embryo reduction is first β-hCG > 1 000 mIU/mL and th e embryo development is normal. (2) Drug method is more effective than mechanica l damage in elective embryo reduction.