多胎妊娠孕中期减至双胎与初始双胎妊娠的妊娠结局比较

目的 探讨多胎妊娠孕妇孕中期行减胎术减至双胎后与初始双胎孕妇的妊娠结局比较.方法 选择2007年8月至2010年9月在山东大学附属省立医院妇产科门诊或住院、多胎妊娠孕妇567例,其中双胎妊娠孕妇478例为非减胎组;妊娠12周以后在本院实施孕中期减胎术(在超声引导下经腹的胎心内氯化钾注射法),由初始多胎减至双胎的孕妇89例为减胎组.减胎组孕妇中,初始三胎70例,初始四胎13例,初始五胎及以上6例.观察两组孕妇年龄、分娩孕周、妊娠并发症、新生儿出生体质量及新生儿结局.结果 (1)两组孕妇年龄及分娩孕周:非减胎组与减胎组孕妇平均年龄分别为(29.7±4.5)和(29.9±5.0)岁,两组比较,差异无统计学意义(P=0.755).非减胎组与减胎组孕妇平均分娩孕周分别为(35.3±3.9)和(34.4±6.3)周,两组比较,差异有统计学意义(P＜0.01).分娩孕周＜28周者(即流产)在非减胎组发生率为6.3％( 30/478),在减胎组为15.7％( 14/89),两组比较,差异有统计学意义(P=0.002).(2)两组妊娠并发症:子痫前期发生率在非减胎组及减胎组分别为8.2％ (39/478)和12.4％(11/89),两组比较,差异无统计学意义(P=0.199);妊娠期糖尿病发生率在非减胎组及减胎组分别为1.7％(8/478)和3.4％( 3/89),两组比较,差异无统计学意义(P =0.287).(3)两组新生儿情况:①非减胎组两个胎儿出生体质量差值＞400g的发生率为28.9％(138/478),减胎组为27.0％ (24/89),两组比较,差异无统计学意义(P=0.715).非减胎组两个胎儿出生体质量差值＞100g的发生率为75.1％(359/478),减胎组为75.3％(67/89),两组比较,差异无统计学意义(P =0.972).②非减胎组新生儿平均出生体质量为(2700 ±468)g,明显高于减胎组的(2352 ±602)g,两组比较,差异有统计学意义(P＜0.01).非减胎组＞孕36周+1 分娩的新生儿平均出生体质量为(2809 ±424)g,减胎组为(2707±506)g,两组比较,差异有统计学意义(P＜0.01).③减胎组及非减胎组＞28孕周分娩新生儿的死亡率分别为1.3％( 1/78)和2.2％( 10/448);减胎组及非减胎组新生儿患病率分别为3.8％ (3/78)和4.0％ (18/448),两组＞28孕周分娩的新生儿死亡率及患病率分别比较,差异均无统计学意义(P =0.588、0.943).结论 多胎妊娠减胎至双胎的妊娠结局较初始双胎者差,其流产率较高;多胎妊娠减胎后分娩孕周受初始胎儿数的影响,新生儿出生体重质量低于初始双胎.

Comparative study of pregnancy outcomes between spontaneous twin pregnancies and twin pregnancies after fetal reduction in the second trimester

Objective To compare the outcomes of multifetal pregnancy reduced to twins with initial twin pregnancy.Methods This study included all patients who had high-order multiple pregnancies from August 2007 to September 2010 ( n =567 ) in outpatient or inpatient of Department of Obstetrics and Gynecology,Provincial Hospital Affiliated to Shandong University.There were 478 initial twin pregnancys (non-reduced group ) and 89 multifetal pregnancy reduced to twins (reduced group).All fetal reduction procedures were performed after 12 weeks gestation.The maternal ages,gestational ages at delivery,pregnancy complications,birth weight of twins and neonatal outcomes were observed in all groups.Results ( 1 ) Average maternal ages and mean gestational ages at delivery:the average maternal ages were ( 29.7 ± 4.5) and (29.9 ± 5.0 ) years for the non-reduced and reduced groups,respectively,no statistical significance (P =0.755).The mean gestational ages at delivery in the nonreduced and reduced twins were (35.3 ± 3.9) and ( 34.4 ± 6.3 ) weeks,respectively ( P ＜ 0.01 ).( 2 ) Pregnancy complications:the rate of pre-eclampsia was 8.2％ ( 39/478 ) in the nonreduced group and 12.4％ (11/89) in the reduced group,no statistical significance ( P =0.199 ).The rates of gestational diabetes mellitus were 1.7％ ( 8/478 ) and 3.4％ ( 3/89 ),respectively,no statistical significance ( P =0.287 ).( 3 ) Neonatal outcomes:① the frequencies of birth weight discordances ＞ 400 g were 28.9％ for the nonreduced group and 27.0％ for the reduced group,no statistical significance ( P =0.715 ).The frequencies of birth weight discordances ＞ 100 g were 75.1％ for the nonreduced group and 75.3％ for the reduced group,no statistical significance (P =0.972).②The mean birth weight of the nonreduced twin group was significantly higher than that of the reduced group [ ( 2700 ± 468 ) g vs.( 2352 ± 602 ) g,respectively,P ＜ 0.0l ],there was statistical significance.The mean birth weight of gestational ages ＞ 36 +1 weeks at delivery of the nonreduced twin group was significantly higher than that of the reduced group [ (2809 ± 424) g vs.(2707 ± 506) g,respectively,P ＜0.01 ],there is statistical significance.③The rate of infant mortality( gestational ages ＞28 weeks at delivery) was 1.3％ ( 1/78 ) for the reduced group and 2.2％ ( 10/448 ) for the nonreduced group.The major morbidity rate was 3.8％ (3/78) for the reduced group and 4.0％ (18/448) for the nonreduced group,no statistical significance ( P =0.588,0.943 ).Conclusions Multiple pregnancies after fetal reduction were still associated with a mild increased risk when compared to initial twin pregnancies and their abortion rate is high.The gestational ages of the reduced group were affected by the initial number of fetuses,and the birth weights of reduced twins were lower than that of the nonreduced twins.