单卵三胎和四胎妊娠射频减胎术病例报告及文献综述

发布时间：2018-05-09 08:21

本文选题：单卵三胎和四胎 + 发病机制　；参考：《山东大学》2017年硕士论文

【摘要】：与单胎妊娠相比,多胎妊娠,特别是单卵多胎妊娠的母亲和胎儿,发生妊娠相关并发症的风险和严重程度都会有不同程度的增加,造成不良妊娠结局。射频减胎术已广泛用于单绒毛膜双胎妊娠的处理,但单卵三胎和四胎妊娠临床非常罕见,而且其胎盘血.管吻合和胎盘份额分配更加复杂,因此对单卵三胎和四胎妊娠的孕妇施行选择性减胎术,其减胎方法和临床结局仍需进一步探讨。本研究中我们就近年收治的8例单卵三胎和四胎妊娠的射频减胎术病例进行总结,并对文献报道进行综述,希望能对单卵三胎和四胎妊娠的临床处理提供一定的借鉴。2014年3月至2017年1月,山东省立医院产科共收治7例单卵三胎妊娠和1例单卵四胎妊娠病例。这8例病例妊娠年龄为24-34岁,患者均既往体健,无基础疾病,孕早期顺利,无腹痛及阴道流血等表现。6例自诉为自然妊娠,2例为IVF-ET术后妊娠,所有患者均无明显多胎妊娠家族聚集现象。孕16-18周于我院行射频减胎术。妊娠结局:7例最终成功分娩两活婴,均为剖宫产分娩,其中未足月胎膜早破早产2例,重度子痫前期早产1例,足月产4例;1例于减胎术后6天感染、流产;新生儿出生1分钟及5分钟Apgar评分均在7分以上,3例接受住院治疗,1例出现新生儿病理性黄疸,1例出现新生儿喉鸣,未见其他明显异常;患者产后无相关并发症发生,体健。虽然缺乏临床对照,且样本量较少,尚不能得出有关高序单卵多胎妊娠施行射频减胎术的相关临床结论,但从中可见,施行高序单卵多胎妊娠射频减胎术,能够有效降低妊娠流产率、妊娠期合并症发生率及围产儿病死率,对于改善母婴预后意义重大,且在技术上是可行的、安全的。单卵三胎和四胎妊娠自然发生率很低,近年来人工辅助生殖技术的广泛使用,使得其发生率明显升高,但具体机制尚不明确,可能与妊娠年龄、透明带处理、卵巢刺激、胚胎培养时间和遗传等多个因素相关。单卵三胎和四胎妊娠孕产妇出现流产、妊娠期高血压疾病、选择性胎儿生长受限、胎膜早破、胎儿宫内窘迫、胎死宫内、早产等风险均不同程度增加。双胎输血综合征是单卵多胎妊娠特征性的并发症,施行减胎术和激光凝固术是有效的治疗方法。
[Abstract]:Compared with single pregnancy, the risk and severity of pregnancy-related complications will increase in different degrees in multiple pregnancies, especially in mothers and fetuses of single ovum multiple pregnancies, resulting in adverse pregnancy outcomes. Radiofrequency minimization has been widely used in the management of single chorionic twin pregnancy, but the clinical practice of single egg triplet and four pregnancy is very rare, and its placental blood is very rare. Tube anastomosis and placental share distribution are more complicated. Therefore, the method and clinical outcome of selective fetal reduction for single triplets and four pregnancies need to be further explored. In this study, we summarized 8 cases of single ovum triplets and four pregnancies undergoing radiofrequency reduction, and reviewed the literature. From March 2014 to January 2017, a total of 7 cases of monozygotic triple pregnancy and 1 case of one-ovum four-embryo pregnancy were admitted to the Department of Obstetrics of Shandong Provincial Hospital. The gestational age of these 8 cases was 24-34 years old. All the patients were in good health, no underlying diseases, smooth early pregnancy, no abdominal pain and vaginal bleeding. 6 cases of spontaneous pregnancy were diagnosed as spontaneous pregnancy and 2 cases were pregnancy after IVF-ET. There was no significant family aggregation of multiple pregnancies in all patients. 16-18 weeks of gestation were performed in our hospital. At the end of pregnancy, 7 cases were successfully delivered by cesarean section, including 2 cases of premature rupture of unmatured membranes, 1 case of severe preeclampsia, 1 case of term delivery and 1 case of infection 6 days after fetal reduction. The Apgar scores at 1 and 5 minutes of birth were above 7 in 3 cases with neonatal pathological jaundice, 1 case with neonatal larynx and 1 case with no other obvious abnormality, and there were no related complications and physical health after delivery. Although there is a lack of clinical control and a small sample size, it is not possible to draw the relevant clinical conclusions about the application of radiofrequency fetal reduction in high-order single-ovulation multiple pregnancy, but it can be seen from the above that the high-order single-ovulation multiple pregnancy is performed with radiofrequency reduction. It can effectively reduce the rate of abortion of pregnancy, the incidence of complications of pregnancy and the perinatal mortality, which is of great significance to improve the prognosis of mother and child, and is technically feasible and safe. In recent years, the prevalence of artificial assisted reproduction technology has increased significantly, but the specific mechanism is not clear, which may be associated with pregnancy age, treatment of pellucida, ovarian stimulation, the incidence of pregnancy is very low, the use of artificial assisted reproductive technology in recent years, the incidence is significantly increased, but the specific mechanism is not clear. Embryo culture time and heredity are related to many other factors. The risk of abortion, hypertensive disorder complicating pregnancy, selective fetal growth restriction, premature rupture of membranes, fetal distress, fetal death and premature delivery increased in different degrees. Twin transfusion syndrome is a characteristic complication of single ovum multiple pregnancy.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.23

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