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目的探讨多胎妊娠孕中期选择性减胎术后发生不良妊娠结局的危险因素。方法收集2004年5月至2015年9月在山东大学附属省立医院产科住院的经腹多胎妊娠减胎术后发生流产、早产的孕妇68例,并按照每年1∶2的比例随机抽取减胎术后妊娠结局良好的孕妇共136例为对照组;分别从年龄、体重、妊娠方式、早孕期阴道流血情况、减胎术前白细胞计数、总产次、减胎前胎儿数、减胎指征、减胎次数、减胎时孕周、被减胎儿数、保留胎儿数、减胎时有无穿过胎盘、穿刺次数、减胎前有无阴道炎、术后抗生素的使用天数方面收集两组孕妇减胎时的临床资料,进行统计学分析。经腹多胎妊娠减胎术采用目标胎儿心内或颅内氯化钾注射法。结果 (1)初步分析年龄、减胎前胎儿数、保留胎儿数、术中有无穿过胎盘、穿刺次数是减胎后妊娠结局的影响因素(P<0.05),其他因素对减胎后妊娠结局无明显影响(P>0.05)。(2)Logistic多因素回归分析显示术中有无穿过胎盘是独立影响因素(β=-1.143,P<0.005)。结论减胎时穿刺针通过胎盘是经腹减胎术不良妊娠结局的独立危险因素,手术中穿刺位点尽量避开胎盘可能会改善妊娠结局。
Objective To investigate the risk factors of adverse pregnancy outcomes after selective fetal reduction in the second trimester of multiple pregnancy. Methods Sixty-eight pregnant women with abortion and premature labor after hospitalized in the Obstetrics and Gynecology Hospital of Shandong University from May 2004 to September 2015 were randomly divided into two groups according to the ratio of 1: 2 A total of 136 pregnant women with good postoperative pregnancy outcomes were selected as control group. The age, weight, pregnancy pattern, vaginal bleeding during the first trimester, white blood cell count, total fetus before delivery, , The number of times of reducing the number of fetuses, gestational weeks when aborted, the number of aborted fetuses, the number of fetuses kept, the presence or absence of transplacental ablation, the number of punctures, the absence of vaginitis before abortion, and the days of antibiotic use after surgery Pregnant women at the time of clinical data, statistical analysis. Abdominal multiple pregnancy loss of fetal surgery using fetal heart or intracranial potassium chloride injection. Results (1) The age, the number of fetuses before fetus reduction, the number of retained fetuses, the number of intraoperative placenta through the placenta, the number of puncturing were the influencing factors of pregnancy outcome after abortion (P <0.05) No significant effect on outcome (P> 0.05). (2) Logistic multivariate regression analysis showed that intraoperative placenta perfusion was an independent influencing factor (β = -1.143, P <0.005). Conclusions The puncture needle passing through the placenta during abortion is an independent risk factor for adverse pregnancy outcome. Abdominal puncture during operation may avoid pregnancy outcomes.