三胎妊娠减为双胎与未减胎双胎妊娠结局分析

摘要

目的 探讨体外受精-胚胎移植技术(IVF-ET)中孕早期三胎妊娠减为双胎与未减胎双胎孕妇的妊娠结局比较.方法 收集2010年1月至2016年6月西北妇女儿童医院生殖中心行IVF-ET后获得三胎 、双胎的患者共178例,其中128例患者孕6周B超诊断为3个胎芽,均见胎心(三绒毛膜三胎84例,双绒毛膜双羊膜囊三胎44例),于10周内行减胎术;余50例患者孕6周B超诊断为2个胎芽,均可见胎心,并均为双绒毛膜双羊膜囊双胎.比较各组间流产率 、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 减胎组与初始双胎妊娠组在流产率 、早产率 、子痫前期 、糖尿病 、产后出血的发生率及不同孕周两个胎儿出生体质量方面的差异均无统计学意义(χ2/F值分别为:1.24、1.06、1.38、1.68、1.74、2.31、2.67、2.59、1.89,均P>0.05).但双绒毛膜三胎减为双绒毛膜双胎后发生再次自然减胎的概率增加,与各组比较,差异均有统计学意义(χ2=11.31,P<0.05).结论 三胎妊娠减胎术能改善母胎结局,且减胎后流产率的发生与初始双胎相比并无增加,多胎减胎是IVF-ET多胎妊娠的重要补救措施.%Objective To investigate and compare the outcomes of initial twin pregnancy and twin pregnancy reduced from triplet pregnancy in the first trimester assisted by in vitro fertilization-embryo transfer (IVF-ET ) .Methods A total of 178 patients obtaining triple or twin pregnancy assisted by IVF-ET in reproductive center of Northwest Women and Children's Hospital during January 2010 to June 2016 were collected .A total of 128 patients diagnosed with 3 fetal buds with hearts by B ultrasound at 6 weeks of gestation (84 cases of triplet pregnancy with triple chorions ,and 44 cases of dichorionic diamnionic triplet pregnancy ) were selected as reduction group and accepted multifetal pregnancy reduction within 10 weeks ,while another 50 patients diagnosed of 2 fetal buds with hearts by B ultrasound at 6 weeks of gestation (dichorionic diamnionic twin pregnancy) were selected as initial twin group .The abortion rate , gestational age , pregnancy complications , neonatal birth weight and neonatal outcome were compared between two groups .Results There were no significant differences in miscarriage rate ,preterm birth rate ,incidence of preeclampsia ,incidence of diabetes ,incidence of postpartum hemorrhage ,and the fetal birth weight at different gestational weeks between two groups (χ2 /F value was 1 .24 ,1 .06 ,1 .38 ,1 .68 ,1 .74 ,2 .31 ,2 .67 ,2 .59 and 1 .89 ,respectively ,all P > 0 .05) . However ,the probability of spontaneous pregnancy reduction was increased after dichorionic diamnionic triplet pregnancy reducing to dichorionic diamnionic twin pregnancy .The differences among groups were statistically significant (χ2 = 11 .31 ,P < 0 .05) . Conclusion Triplet pregnancy reduction can improve the maternal fetal outcome .And compared with initial twin pregnancy ,it won't increase the incidence of abortion after accepting pregnancy reduction .Therefore ,multiple fetal reduction is an important remedy for multiple pregnancy assisted with IVF-ET .