摘要
目的总结单绒毛膜三羊膜囊(monochorionic triamniotic,MCTA)三胎的妊娠结局及减胎术对其的影响。方法回顾性纳入2012年1月1日至2020年1月1日于北京大学第三医院分娩的23例MCTA三胎病例,均于早孕期在本院产前检查,根据孕妇是否接受减胎分为选择性减胎组(随机减去一胎保留双胎,8例)及期待妊娠组(15例)。比较组间年龄、妊娠终止孕周及妊娠结局的差异。选择性减胎组再根据减胎方式分为早孕期负压抽吸减胎组(3例)及中孕期射频消融减胎组(5例),比较组间妊娠结局的差异。采用两独立样本t检验及Fisher精确概率法进行统计学分析。结果(1)期待妊娠组与选择性减胎组比较:妊娠终止孕周[(31.7±4.1)与(28.8±8.8)周]、32周后早产率(9/15与4/8)、至少二孩存活率(12/15与4/8)、至少一孩存活率(13/15与5/8)差异均无统计学意义(P值均>0.05)。期待妊娠组发生双胎输血综合征1例,于孕19周行胎儿镜手术,33周^(+2)胎膜早破,行剖宫产分娩三胎;孕17周发生双胎反向动脉灌注序列征1例,拒绝减胎,孕33周一胎儿胎心消失存活一孩(另一胎为无心畸胎)。(2)不同减胎方式亚组妊娠结局比较:早孕期负压抽吸减胎组与中孕期射频消融减胎组平均妊娠终止孕周[(28.5±7.6)与(28.9±10.4)周,t=1.145,P>0.05]以及至少一孩存活率(2/3与3/5)、至少二孩存活率(2/3与2/5)差异均无统计学意义(Fisher精确概率法,P值均>0.05)。均未出现减胎术后感染和胎膜渗漏。结论对于MCTA三胎妊娠,选择性减胎与期待妊娠相比母胎结局基本无差异。
Objective To summarize the pregnancy outcome of monochorionic triamniotic(MCTA)triplet pregnancy and its relationship with multifetal pregnancy reduction.Methods This study retrospectively recruited 23 women with MCTA pregnancy who delivered at Peking University Third Hospital from January 1,2012,to January 1,2020.All 23 cases received regular prenatal examination at our hospital from the first trimester,who were divided into two groups:selective fetal reduction group(randomly reduced one fetus,n=8)and expectant group(n=15).Pregnancy outcome was described in all participants,differences in maternal age,gestational weeks and outcomes were compared between the two groups.The selective fetal reduction group was further divided into two subgroups:first-trimester vacuum aspiration group(n=3)and second-trimester radiofrequency ablation group(n=5),to evaluate the differences in pregnancy outcomes.Two independent samples-t test and Fisher's exact test were used as statistical methods.Results(1)There was no significant difference in the gestational weeks at the end of the pregnancy[(31.7±4.1)vs(28.8±8.8)weeks],preterm delivery after 32 weeks(9/15 vs 4/8),at least two surviving children(12/15 vs 4/8)and at least one surviving child(13/15 vs 5/8)between the expectant group and the selective fetal reduction group(all P>0.05).One case with twin-twin transfusion syndrome in the expectant group underwent fetoscopic surgery at 19 weeks of gestation and delivered three live infants through cesarean section at 33^(+2) weeks due to premature rupture of membranes.One case with twin reversed arterial perfusion sequence at 17 weeks of gestation refused fetal reduction and gave birth to a child at 33 weeks when one fetus's heart stopped beating and one was acardia.(2)The first-trimester vacuum aspiration group and the second-trimester radiofrequency ablation group showed no significant differences in the average gestational weeks at the end of the pregnancy[(28.5±7.6)vs(28.9±10.4)weeks,t=1.145,P>0.05],or the rate of at least one(2/3 vs 3/5,Fisher's exact test,P>0.05)or two surviving children(2/3 vs 2/5,Fisher's exact test,P>0.05).No postoperative infection or amniotic fluid leakage was reported in the subgroups.Conclusions The pregnancy outcome of MCTA triplet with fetal reduction is not different with expectant group.
作者
周颖
焦钰洁
朱培静
原鹏波
王学举
宫晓丽
赵扬玉
魏瑗
Zhou Ying;Jiao Yujie;Zhu Peijing;Yuan Pengbo;Wang Xueju;Gong Xiaoli;Zhao Yangyu;Wei Yuan(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Tongzhou District Maternal and Child Health Hospital,Beijing 101100,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2021年第4期249-253,共5页
Chinese Journal of Perinatal Medicine
基金
国家重点研发计划(2018YFC1002904)
首都临床诊疗技术研究及转化应用(Z201100005520074)。
关键词
妊娠
三胎
妊娠减少
多胎
妊娠结局
回顾性研究
Pregnancy,triplet
Pregnancy reduction,multifetal
Pregnancy outcome
Retrospective studies
