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目的:探讨辅助生殖技术(ART)中多胎妊娠早期选择性减胎术的临床应用价值。方法:在阴道B超引导下,对减胎组92例多胎妊娠采用单纯抽吸胚胎组织或机械绞杀法,减灭胚胎。对照组为未行减胎术的妊娠患者。结果:192例多胎妊娠一次减胎成功率100%(92/92),晚期流产发生率7.61%(7/92),早产率6.52%(6/92),足月分娩率85.87%(79/92);2减胎组单胎较双胎妊娠在早产发生率(11.27%vs 42.86%)与低体重儿发生率(5.63%vs 21.88%)上明显下降,均有显著性差异(P<0.05)。而与对照组单胎妊娠在早产发生率(11.27%vs 10.61%)、低体重儿发生率(5.63%vs 7.58%)上无显著性差异(P>0.05);两组双胎妊娠在早产发生率(42.86%vs 34.78%)、低体重儿发生率(21.88%vs 26.08%)上均无显著性差异;3减胎组中单胎较双胎妊娠在晚期流产率(6.58%vs 12.50%)、抱婴回家率(97.18%vs 92.86%)、妊娠高血压发生率(1.32%vs 0.63%)和妊娠期糖尿病发生率(1.32%vs 0.00%)上均无显著性差异(P>0.05)。结论:1阴道超声引导下多胎妊娠减胎术是一种安全、行之有效的微创技术,是ART多胎妊娠有效的补救措施;2减胎术后单胎活产较双胎活产获得更好的妊娠结局。
Objective: To investigate the clinical value of selective fetal reduction in multiple pregnancy during assisted reproductive technology (ART). Methods: Under the guidance of vaginal ultrasound B, embryo was ablated by using aspiration embryo tissue or mechanical strangulation in 92 cases of multiple pregnancy in abortion group. The control group was non-abortion pregnancy patients. Results: The success rate of one-time fetus abortion in 192 multiple pregnancies was 100% (92/92), 7.61% (7/92) in late pregnancy, 6.52% (6/92) in premature delivery and 85.87% (79 / 92). The incidence of preterm birth was significantly lower in single abortion group than in twin pregnancy group (11.27% vs 42.86% vs 5.63% vs 21.88%, P <0.05) ). Compared with the control group, there was no significant difference in the incidence of prematurity (11.27% vs 10.61%) and low birth weight (5.63% vs 7.58%) (P> 0.05) (42.86% vs 34.78%) and low birth weight infants (21.88% vs 26.08%). No significant difference was found in the rates of late abortion (6.58% vs 12.50% (97.18% vs 92.86%), the incidence of pregnancy-induced hypertension (1.32% vs 0.63%) and gestational diabetes mellitus (1.32% vs 0.00%) did not differ significantly (P> 0.05) . Conclusion: 1 vaginal ultrasound-guided multiple pregnancy reduction is a safe and effective minimally invasive technique, which is an effective remedy for ART multiple pregnancies. Good pregnancy outcome.