双胎妊娠孕中晚期经腹选择性减胎临床分析

Clinical analysis of selective fetal reduction via abdominal approach during the second and the third trimesters of twin pregnancy

摘要

目的 评估双绒毛膜双羊膜囊(DCDA)双胎妊娠孕中晚期经腹选择性减胎手术的安全性、有效性。方法 回顾性分析2020年7月至2023年7月在空军军医大学第一附属医院妇产科生殖中心进行经腹选择性减胎手术的18例DCDA双胎孕妇的临床资料,均采用经腹胎儿心腔注射10%氯化钾的方法进行减胎.另选取同期本中心随访的87例未行减胎的正常DCDA双胎孕妇作为对照组,分别调查并比较两组妊娠结局、新生儿出生状况等。结果 18例减胎手术均一次获得成功,保留胎儿均获活产,分娩孕周(36.62±3.17)周,新生儿出生体重(2813±734)g,随访18例新生儿目前身体健康状况良好,身体及运动发育指标均正常,均无神经系统异常.与87例未行减胎的正常DCDA双胎比较,早产率和新生儿出生孕周无显著性差异(P>0.05),但选择性减胎组有更高的新生儿出生体重(t=-2.593,P<0.05)。结论 双绒毛膜双羊膜囊双胎孕中晚期出现一胎异常时,可选择经腹超声引导下胎儿心腔注射10%氯化钾的方法进行选择性减胎,治疗方法可靠,安全性高.

Abstract

Objective To evaluate safety and efficacy of selective fetal reduction via abdominal approach for dichorionic diamniotic (DCDA) twin pregnancy in the second and the third trimesters of pregnancy. Methods The clinical data of 18 DCDA twin pregnant women who underwent selective fetal reduction surgery via abdominal approach in Reproductive Center, Department of Gynecology and Obstetrics of our hospital from July 2020 to July 2023 were retrospectively analyzed. These 18 pregnant women with DCDA twin pregnancy underwent selective fetal reduction via abdominal approach by injecting 10% potassium chloride into the fetal heart under abdominal ultrasound guidance during the second trimester or the third trimester of pregnancy (selective fetal reduction surgery group). 87 normal pregnant women with DCDA twin pregnancy who did not undergo selective fetal reduction surgery and were followed up at our center in the same period were selected as control group. The pregnancy outcomes such as gestational age at delivery, preterm birth rate, birth weight of the newborn and the newborns' outcomes were summed up and compared between the two groups. Results In the selective fetal reduction surgery group, all 18 fetal reduction surgeries were successful at the first attempt, and all retained fetuses gave live birth after the surgery. The mean gestational age at delivery of the newborn in the selective fetal reduction group was (36.62±3.17) weeks, and the mean birth weight was (2813±734) g. Follow-up of the 18 newborns in the selective fetal reduction group revealed that they had good current health status, their physical and motor development indicators were normal and hadn't any neurological abnormalities. There were no significant differences in preterm birth rate and gestational age at delivery between the selective fetal reduction group and the control group. However, these newborn in the selective reduction group had higher birth weight (t=-2.593, P<0.05). Conclusion When one fetus in a DCDA twin pregnancy exhibits abnormalities during the second or the third trimesters of pregnancy, selective fetal reduction can be performed by using abdominal ultrasound-guided fetal heart chamber injection of 10% potassium chloride, which is reliable and safe.

关键词

双胎妊娠 / 双绒毛膜双羊膜囊 / 选择性减胎 / 孕中晚期 / 妊娠结局

Key words

twin pregnancy / dichorionic diamniotic / selective fetal reduction / the second and the third trimesters of pregnancy / pregnancy outcome

参考文献

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基金资助

陕西省创新能力支撑计划(2024CXGGXPTG32)