目的：分析氯化钾（KCl）减胎术对多胎妊娠结局的影响。方法：回顾性分析2018年—2023年在长沙市妇幼保健院母胎医学科减胎孕妇的临床资料,41例三胎/双胎孕妇选择经腹胎儿心脏内注射氯KCl减胎,并追踪随访至新生儿出生后1~4岁。结果：41例孕妇25例为试管受孕,16例为自然受孕。保留单胎组（31例）孕妇平均年龄（30.53±4.22）岁,减胎孕周21.65（16.08,26）周,1例流产,30例孕妇顺利分娩,平均分娩孕周37.3（34.2,39）周,新生儿出生体重平均（2646.67±761.57）g,剖宫产率40%,产后出血量平均300 （200,300）mL。保留双胎组（10例）孕妇平均年龄31.75±5.17岁,减胎孕周12.55（12.1,13.75）周。2例流产,8例孕妇顺利分娩,平均分娩孕周35.5（30.75,36.75）周,新生儿出生体重平均（2193.75±650.51）g,剖宫产率87.5%,产后出血量平均300（300,500）mL。存活新生儿追踪随访1~4年未发现婴幼儿神经系统等发育异常。结论：孕中期经腹选择性KCl减胎术是一种安全的治疗手段,可有效解决多胎妊娠所带来的妊娠风险,同时也可避免双胎之一发育异常胎儿的出生,防止缺陷儿的出生,提高人口质量,降低妊娠风险,改善妊娠结局,其中保留单胎比保留双胎的孕妇剖宫产率及产后出血率更低,围产期结局更优。
Abstract
Objective This study was designed to evaluate the impact of potassium chloride (KCl) reduction surgery on the outcome of multiple pregnancies. Methods A retrospective analysis was conducted on the clinical data of pregnant women who underwent fetal reduction at the Maternal and Fetal Medicine Department of Changsha Maternal and Child Health Hospital from 2018 to 2023. Forty one pregnant women with three or two fetuses were selected to undergo intraperitoneal injection of KCl into the fetal heart for fetal reduction, and follow-up investigation was conducted until the age of 1~4 years after birth. Results Among the 41 pregnant women, 25 underwent in vitro fertilization, and 16 came from natural fertilization. The average age of pregnant women in the retained singleton group was (30.53±4.22)years old, with a reduced gestational age of 21.65 (16.08, 26) weeks. One miscarriage occurred, and the remaining 30 pregnant women were delivered smoothly. The average gestational age was 37.3 (34.2, 39) weeks, and the average birth weight of newborns was (2 646.67±761.57)g. The cesarean section rate was 40%, while the average postpartum hemorrhage was 300 (200, 300) mL. The average age of retained twin group pregnant women was (31.75±5.17) years old, with a reduced gestational age of 12.55 (12.1, 13.75) weeks. Two miscarriages occurred, and 8 pregnant women in the twin group were successfully delivered with an average gestational age of 35.5 (30.75, 36.75) weeks. The average birth weight of the newborn was (2 193.75±650.51)g, while the cesarean section rate was 87.5%. The average postpartum bleeding volume was 300 (300, 500) mL. Surviving newborns were followed up for 1-4 years without any developmental abnormalities in the infants' nervous system. Conclusion Mid pregnancy selective KCl reduction surgery is a safe treatment method that can effectively reduce the pregnancy risks associated with multiple pregnancies. It can also avoid the birth of one of the twin fetuses with abnormal development, prevent the birth of defective babies, improve population quality, reduce pregnancy risks, and improve pregnancy outcomes. Among them, retaining a single pregnancy has a lower cesarean section rate and postpartum hemorrhage rate than retaining a twin pregnancy and better perinatal outcomes.
关键词
多胎妊娠 /
氯化钾 /
减胎 /
妊娠结局
Key words
multiple pregnancies /
KCl /
fetal reduction /
pregnancy outcome
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] KARAMUSTAFAOGLU BALCI B, YAYLA M, BULUT N, et al.Expectant management of triplets or multifetal reduction to twins; comparison of preterm delivery and live birth rates[J]. Eur J Obstet Gynecol Reprod Biol, 2022 ,268:18-21.
[2] D'ALTON M, BRESLIN N. Management of multiple gestations[J]. Int J Gynaecol Obstet, 2020, 150(1): 3-9.
[3] LI N, SUN J, WANG J, et al.Selective termination of the fetus in multiple pregnancies using ultrasound-guided radiofrequency ablation[J]. BMC Pregnancy Childbirth, 2021, 21(1): 821.
[4] PIKE GK.The Changing Face of Feticide in Multiple Pregnancies[J]. Issues Law Med, 2022, 37(1): 3-28.
[5] 刘兴会, 张力. 重视多胎妊娠的规范诊治[J]. 中国实用妇科与产科杂志, 2009, 25(6): 401-404.
[6] KIM MS, KANG S, KIM Y, et al.Transabdominal fetal reduction: a report of 124 cases[J]. J Obstet Gynaecol, 2021, 41(1): 32-37.
[7] 李南, 王佳燕, 陈敏, 等. 超声引导下氯化钾选择性减胎术131例分析[J]. 中国医学创新, 2017, 14(10): 1-4.
[8] ZEMET R, HAAS J, BART Y, et al.Pregnancy outcome after multifetal pregnancy reduction of triplets to twins versus reduction to singletons[J]. Reprod Biomed Online, 2020, 40(3): 445-452.
[9] ANTHOULAKIS C, DAGKLIS T, MAMOPOULOS A, et al.Risks of miscarriage or preterm delivery in trichorionic and dichorionic triplet pregnancies with embryo reduction versus expectant management: a systematic review and meta-analysis[J]. Hum Reprod, 2017, 32(6): 1351-1359.
[10] SHAW CJ, PARAMASIVAM G, VACCA C, et al.Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre experience[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 264: 200-205.
[11] 张琴, 沈金华, 田玫, 等. 辅助生殖技术单胎活产儿出生缺陷率分析[J]. 湖南师范大学学报(医学版), 2019, 16(01): 30-34.
[12] JIN B, HUANG Q, JI M, et al.Perinatal outcomes in dichorionic diamniotic twins with multifetal pregnancy reduction versus expectant management: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2020, 99(25): e20730.
[13] 胡琳莉, 王秀霞, 张松英, 等. 多胎妊娠减胎术操作规范(2016)[J]. 生殖医学杂志, 2017, 26(3): 193-198.
[14] HAAS J, HOURVITZ A, DOR J, et al.Perinatal outcome of twin pregnancies after early transvaginal multifetal pregnancy reduction[J]. Fertil Steril, 2014, 101(5): 1344-1348.
[15] HAAS J, BARZILAY E, HOURVITZ A, et al.Outcome of early versus late multifetal pregnancy reduction[J]. Reprod Biomed Online, 2016, 33(5): 629-634.
[16] KIM MS, CHOI DH, KWON H, et al.Procedural and obstetric outcomes after embryo reduction vs fetal reduction in multifetal pregnancy[J]. Ultrasound Obstet Gynecol, 2019, 53(2): 214-218.
[17] WU T, GONG X, WANG X, et al.Perinatal and neurodevelopmental outcome in complicated monochorionic pregnancy after selective fetal reduction: radiofrequency ablation vs microwave ablation[J]. Ultrasound Obstet Gynecol, 2022, 60(4): 506-513.
[18] 孙澳, 吴天晨, 魏瑗. 减胎术对孕妇心理健康影响的研究进展[J]. 中国生育健康杂志, 2023, 34(01): 94-97.
[19] 来天娇, 郭艺红. 多胎妊娠减胎术伦理争议[J]. 生殖医学杂志, 2017, 26(3): 219-223.
[20] 黎欣盈, 张念樵, 钟筱. 人类辅助生殖技术应用的伦理问题及工作实践[J]. 中国医学伦理学, 2021, 34(7): 856-860.
基金
湖南省胎儿先心病遗传研究临床医疗技术示范基地基金资助项目（2021SK4036）; 湖南省科技厅“惠普性政策与创新新环境建设计划-临床医疗技术创新引导项目”（2020SK53103）
PDF(2061 KB)
