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目的通过对多胎妊娠妇女于孕中期行选择性减胎术,研究其手术指征、时机、安全性、目标胎儿的选择标准和减灭胎儿数,探讨选择性减胎术在改善多胎妊娠结局中的作用。方法对37例孕12周~(+1)～25周多胎妊娠孕妇(6例双胎、21例三胎、8例四胎、2例五胎,共117个胎儿)在超声引导下经腹行选择性减胎术,按产科医疗指征,在拟被减的46个胎儿心脏内注射10%氯化钾2～5 ml,见胎心逐渐减慢至停跳视为减胎术成功。术后定期产前检查和监测凝血功能,记录妊娠期并发症及妊娠结局。结果 (1)成功率:共减去胎儿46个,减胎成功率为100%(46/46个胎儿),已有27例孕妇分娩,获24个健康新生儿,妊娠成功率为88.9%(24/27)。(2)分娩孕周:>36周分娩者15例;32～36周7例;28～32周3例;<28周流产者2例;正在妊娠中10例。平均分娩孕周(34.9±4.1)周,孕28周后分娩率为92.6%(25/27)。(3)新生儿平均出生体重:单胎妊娠新生儿平均出生体重为(3014±640)g,双胎妊娠为(2557±573)g,三胎妊娠中除1例两个胎儿存活(出生体重分别为1400及1500 g)外,其余均死亡。(4)安全性:除2例单羊膜囊双胎在减灭1个胎儿后,另1个胎儿随即死亡外,其余多胎妊娠妇女的保留胎儿均未发生胎死宫内。(5)并发症:37例多胎妊娠妇女中仅3例发生子痫前期,减胎术后均无凝血功能障碍发生。(6)阴道流血:有13例孕妇减胎术前发生阴道流血,其中1例在妊娠13周强烈要求减胎,减胎术后于孕22周流产;另12例均在阴道流血停止1周以上后施行减胎。结论 (1)孕中期选择性多胎妊娠减胎术,可以有效减少多胎妊娠胎儿数目、避免异常胎儿出生,降低孕产妇并发症,提高新生儿出生体重。(2)胎儿保留数目以达双胎为好。(3)减胎术前有阴道流血者,避免在流血期间减胎,应选择在流血停止1周以上进行。(4)孕中期多胎妊娠减胎术不会造成孕妇的凝血功能障碍,也不会造成保留胎儿的宫内死亡,安全性好;减胎术后子痫前期的发病率明显下降。
Objective To study the indications, timing, safety, target selection criteria and the number of fetuses to be ablated in pregnant women with multiple pregnancies during the second trimester of pregnancy. To explore the effect of selective abortion on improvement of multiple pregnancy outcomes Role. Methods Thirty-seven pregnant women with multiple pregnancies (6 twins, 21 third-fetuses, 8 fourth-fetuses, and 2 fifth-fetuses, 117 fetuses) were enrolled in this study. Line selective abortion, according to obstetric indications, to be reduced by 46 fetal heart injection of 10% potassium chloride 2 ~ 5 ml, see the fetal heart rate gradually reduced to arrest as the success of abortion. Postoperative regular prenatal examination and monitoring of coagulation, pregnancy complications and pregnancy outcomes recorded. Results (1) The success rate: 46 fetuses were subtracted, the success rate of abortion was 100% (46/46 fetuses). There were 27 pregnant women giving birth and 24 healthy newborns with a pregnancy success rate of 88.9% 24/27). (2) gestational age of childbirth:> 36 weeks of delivery in 15 cases; 32 to 36 weeks in 7 cases; 28 to 32 weeks in 3 cases; <28 weeks of abortion in 2 cases; 10 cases of pregnancy. The average gestational age of delivery was 34.9 ± 4.1 weeks, and the delivery rate was 92.6% (25/27) after 28 weeks’ gestation. (3) The average birth weight of newborns: the average birth weight of singleton babies was (3014 ± 640) g and that of twin fetuses was (2557 ± 573) g, except one fetus survived Respectively 1400 and 1500 g), the rest were killed. (4) Safety: In addition to 2 cases of single amniotic sac twins in the reduction of a fetus, the other one died immediately, the rest of the multiple pregnancies of pregnant women did not have fetuses retained fetus intrauterine. (5) Complications: Only 3 of 37 pregnant women with multiple pregnancies developed preeclampsia, and no coagulation dysfunction occurred after abortion. (6) vaginal bleeding: there are 13 cases of premature vaginal bleeding in premature labor, one case of 13 weeks of gestation strong demand for abortion, abortion after 22 weeks of pregnancy abortion; the other 12 cases were stopped in the vaginal bleeding for a week After the implementation of tire reduction. Conclusion (1) The second trimester pregnancy reduction by selective multiple pregnancy can effectively reduce the number of multiple pregnancy fetuses, avoid abnormal fetuses, reduce maternal complications and increase newborns’ birth weight. (2) The number of fetuses to keep twins as well. (3) preoperative vaginal bleeding before surgery to avoid abortion during the bleeding, should choose to stop bleeding for more than 1 week. (4) Maternal trimester abortion will not result in coagulation dysfunction in pregnant women, and will not cause intrauterine death of fetus retained, so the safety is good; the incidence of preeclampsia after abortion reduced obviously.