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目的:比较体外受精-胚胎移植后3胎妊娠行减胎术患者与未行减胎术患者的妊娠结局。方法:回顾性分析2002年1月~2005年12月于我院生殖中心行辅助生育技术后获3胎妊娠的20例患者,按有无行减胎术分组,未减胎组5例,减胎(减为双胎妊娠)组15例。15例减胎术根据胚芽大小采用经阴道B超引导下的微创减胎术,包括抽吸胚芽、抽吸加机械破坏和注射氯化钾3种方法。比较两组的流产率、早产率、分娩时平均孕周、新生儿平均出生体重和<2 500 g低出生体重新生儿的比例。结果:两组流产率无差异,减胎组无术后1个月内近期流产病例;未减胎组和减胎组的早产率分别为100%和30.8%,差异显著(P<0.05),相对危险度为3.25;未减胎组和减胎组分娩时的平均孕周、新生儿平均出生体重分别为(31.8±1.5)周和(36.9±1.6)周、(1 720±194)g和(2 584±428)g,差异显著(P=0.000);<2 500 g的低出生体重新生儿比例未减胎组比减胎组明显增加(P=0.000)。结论:对体外受精-胚胎移植后3胎妊娠的患者行减胎术减为双胎可以显著改善妊娠结局,早期妊娠胚胎减灭术安全、有效。
OBJECTIVE: To compare the pregnancy outcome of patients who underwent IVF with three pregnancies after in vitro fertilization-embryo transfer. Methods: Twenty patients with 3 gestational pregnancies after assisted reproductive surgery in our reproductive center from January 2002 to December 2005 were retrospectively analyzed. Among them, 5 Tire (reduced to twin pregnancy) group of 15 cases. 15 cases of abortion based on the size of the embryo by transvaginal B-guided minimally invasive surgery, including suction embryos, suction plus mechanical damage and injection of potassium chloride 3 kinds of methods. The abortion rate, preterm birth rate, mean gestational age at delivery, mean neonatal birth weight, and neonates with a low birth weight (<2,500 g) were compared between the two groups. Results: There was no difference in abortion rates between the two groups. The abortion group had no recent abortion cases within one month after operation. The premature birth rates were 100% and 30.8% respectively in the untreated and abatement groups (P <0.05) The relative risk was 3.25. The average newborns’ average birth weight at the time of delivery was (31.8 ± 1.5) weeks and (36.9 ± 1.6) weeks, (1 720 ± 194) g and (2 584 ± 428) g, the difference was significant (P = 0.000). The proportion of neonates with low birth weight less than 2 500 g was significantly increased (P = 0.000). CONCLUSIONS: The reduction of twin pregnancies to triplets after in vitro fertilization-embryo transfer can significantly improve pregnancy outcome. Early embryo ablation is safe and effective.