三胎妊娠孕妇实施减胎术后双胎或单胎的妊娠结局及流产率发生风险的分析

发布时间：2018-05-23 17:57

本文选题：妊娠 + 三胎　；参考：《山东大学》2015年硕士论文

【摘要】：目的探讨对三胎妊娠孕妇实施减胎术后双胎或单胎的妊娠结局及流产率、母体妊娠期高血压疾病、妊娠期糖尿病的发生风险的分析。方法收集2001年9月—2014年3月在山东大学附属省立医院妇产科实施减胎术的282例三胎妊娠孕妇(其中自然受孕11例,其余均为辅助生殖技术助孕(assisted reproductive technologies, ART)),根据保留胎儿数目分成由三胎妊娠减至双胎者231例(双胎组)；由三胎妊娠减至单胎者51例(单胎组)。双胎组因胎儿畸形和孕妇要求减至双胎；单胎组因孕妇要求和双绒毛膜三羊膜囊三胎妊娠(DCTA)减至单胎。在282例三胎妊娠中,口服促排卵药物共37.2%(105/282),IVF-ET共58.9%(166/282),自然受孕共3.9%(11/282)。两组孕妇减胎时平均孕周为(14.9±2.6)周,孕周范围为(11.6-22.5)周。孕妇平均年龄(29.73±4.23)岁。本研究采用目标胎儿心内注射氯化钾(potassium chloride, KCL)法减胎术。分析两组妊娠结局、妊娠结束孕周、新生儿出生体质量、母体妊娠期糖尿病(gestational diabetes mellitus, GDM)、妊娠期高血压疾病患病率等。至少1个新生儿存活为妊娠成功；GDM、妊娠期高血压疾病诊断标准,参考我国卫生部分别于2011、2012年发布的行业标准；结果1.总妊娠成功率为91.5%(258/282),双胎组新生儿总数为413例,除去4例死亡新生儿,新生儿存活409例,妊娠成功率为90.5%(209/231)；单胎组新生儿总数为49例,除去2例孕中期流产,妊娠成功率为96.1%(49/51),两组新生儿存活率比较,差异无统计学意义(P0.05)。2.双胎组减胎时平均孕周为(16.5±3.5)周,单胎组为(14.2±2.0)周,将减胎孕周分为孕11-13周“、孕14-16周+6、≥17孕周3个时段,双胎组减胎孕妇分别为129例(55.8%,129/231)、50例(21.6%,50/231)、52例(22.5%,52/231)；单胎组减胎孕妇分别为27例(52.9%,27/51)、16例(31.4%,16/51)、8例(15.7%,8/51),两组不同减胎孕周时段的孕妇数比较,差异均无统计学意义(P0.05)。3.双胎组孕11～13周+6、孕14-16周“、≥17孕周流产率分别为7.0%(9/129)、12.0%(6/50)、9.6%(5/52)；单胎组分别为3.7%(1/27)、0(0/16)、1/8,两组不同孕周流产率分别比较,差异均无统计学意义(P0.05)。4.双胎组和单胎组新生儿平均出生体质量分别为(2 555±447)及(3 084±550)g, 两组比较,差异有统计学意义(P0.05)；双胎组及单胎组低出生体质量儿(2 499 g)分别为45.5%(188/413)及8.2%(4/49),两组差异有统计学意义(P0.05)；双胎组极低出生体质量儿(1499 g)发生率3.9%(16/413)与单胎组0(0/49)比较,差异无统计学意义(P0.05)。双胎组孕妇231例中202例已正常分娩,其中双胎体质量生长不一致(出生体质量相差15%-19%和≥20%)分别占12.4%(25/202)及15.3%(31/202)。5.双胎组孕妇平均分娩孕周为(36.2±2.4)周,单胎组孕妇平均分娩孕周为(38.3±2.2)周,两组比较,差异有统计学意义(P0.05)。对两组孕妇孕34～36周+6及≥37周的分娩率分别进行比较,差异均有统计学意义(P0.05)。双胎组孕妇足月分娩率为47.6%(110/231),单胎组为88.2%(45/51),两组比较,差异有统计学意义(P0.05)。双胎组孕妇28孕周的流产率为8.7%(20/231),单胎组为3.9%(2/51),两组比较,差异无统计学意义(P0.05)。6.妊娠期高血压疾病以及GDM在282例三胎妊娠减胎病例中总的发病率分别为8.9%(25/282)、4.6%(13/282)；母体发生妊娠期高血压患病率在双胎组、单胎组分别为10.4%(24/231)、2.0%(1/51),尽管两组无明显差异(P0.05)但是双胎组比单胎组母体妊娠期高血压疾病患病率增高；妊娠期糖尿病在二组的比例分别为4.8%(11/231)、3.9%(2/51),相差不大,但统计学无明显意义(P0.05)；两组剖宫产率分别为90.0%(208/231)、58.8%(30/51),差异有统计学意义(P0.05)。结论三胎妊娠孕妇经减胎术减至单胎的妊娠结局比减至双胎者更好,减至单胎者并没有增加流产的发生风险,降低了剖宫产率；对于三胎妊娠可建议或接受孕妇的意见减至单胎以更好改善妊娠结局。
[Abstract]:Objective to investigate the pregnancy outcome and abortion rate, maternal pregnancy induced hypertension and the risk of gestational diabetes in three pregnant women with pregnancy reduction, and to collect 282 cases of three pregnant women from September 2001 to March 2014 in the obstetrics and Gynecology Department of the affiliated Provincial Hospital of Shandong University. There were 11 cases of pregnancy, and the rest were assisted reproductive technology (assisted reproductive technologies, ART). According to the number of retained fetuses, 231 cases (double fetus) were reduced from three pregnancy to double fetus; 51 cases (single fetus) were reduced from three fetal pregnancy to single fetus. The three fetal pregnancy (DCTA) and double chorionic membrane sac were reduced to single fetus. In 282 cases of three pregnancy, oral administration of ovulation was 37.2% (105/282), IVF-ET was 58.9% (166/282), and natural pregnancy was 3.9% (11/282). The average pregnancy weeks in two groups of pregnant women were (14.9 + 2.6) weeks and the range of pregnancy was (11.6-22.5) weeks. The average age of pregnant women was (29.73 + 4.23) years. This study was studied in this study. Two groups of pregnancy outcomes, pregnancy end pregnancy, neonatal birth body mass, maternal gestational diabetes (gestational diabetes mellitus, GDM), pregnancy induced hypertension disease rate, etc. were analyzed in two groups of pregnancy outcomes, pregnancy end pregnancy, maternal gestational diabetes (GDM), and pregnancy induced hypertension. At least 1 newborns survived pregnancy success; GDM, pregnancy. The criteria for diagnosis of hypertension, refer to the industry standard published in 20112012 years in China's health section. Results the total success rate of 1. pregnancy was 91.5% (258/282), and the total number of newborn infants in the double fetus group was 413, 4 newborn babies, 409 newborns and 90.5% (209/231) pregnancy success rate; the total number of newborns in the single fetus group was 49, except 2. The successful rate of pregnancy was 96.1% (49/51). There was no significant difference in the survival rate between the two groups (P0.05). The average pregnancy week was (16.5 + 3.5) weeks (16.5 + 3.5) weeks, and the single fetus group was (14.2 + 2) weeks, and the gestational weeks were divided into 11-13 weeks, 14-16 weeks of pregnancy and 3 periods of more than 17 gestational weeks, and the pregnant women in the double fetus group were respectively (129 cases). 55.8%, 129/231), 50 cases (21.6%, 50/231), 52 cases (22.5%, 52/231), 27 cases (52.9%, 27/51), 16 cases (31.4%, 16/51), 8 cases (15.7%, 8/51) in single fetus group, and there was no statistical significance (P0.05).3. double fetus 21.6% weeks, 21.6% weeks of pregnancy. 0% (9/129), 12% (6/50), 9.6% (5/52), single fetus 3.7% (1/27), 0 (0/16), 1/8, two groups, the difference was not statistically significant (P0.05) the average birth weight of the twins and the single fetus group were (2555 + 447) and (3084 + 550) g respectively, and the difference was statistically significant (P0.05) in the two group (P0.05). The low birth weight infants (2499 g) were 45.5% (188/413) and 8.2% (4/49) respectively, and the two groups were statistically significant (P0.05). The incidence of extremely low birth weight (1499 g) in double fetus group was 3.9% (16/413) and 0 (0/49) of single fetus group (P0.05). In the double fetus group, 202 cases of pregnant women in 231 cases had normal childbirth, of which twins were twins. The inconsistency of body mass growth (15%-19% and > 20%) was 12.4% (25/202) and 15.3% (31/202).5. twins, respectively (36.2 + 2.4) weeks, and the average pregnancy weeks were (38.3 + 2.2) weeks in single fetus group. The difference was statistically significant (P0.05) in two groups (P0.05). The scores of 34~36 weeks +6 and more than 37 weeks of pregnant women in two groups of pregnant women were divided. The rate of delivery was statistically significant (P0.05). The full term delivery rate was 47.6% (110/231) and 88.2% (45/51) in the single fetus group. The difference between the two groups was statistically significant (P0.05). The abortion rate of the pregnant women in the twins group was 8.7% (20/231), and the single fetus group was 3.9% (2/51). The two groups were not statistically significant (P0.05).6.. The total incidence of pregnancy induced hypertension and GDM in 282 cases of three pregnancy reduction was 8.9% (25/282) and 4.6% (13/282). The incidence of hypertension in pregnant women was 10.4% (24/231) and 2% (1/51) in the single fetus group, although there was no significant difference between the two groups (P0.05), but the double fetus group was higher than the single fetus during pregnancy. The prevalence of pressure disease increased; the proportion of gestational diabetes in the two groups was 4.8% (11/231) and 3.9% (2/51), but the difference was not significant (P0.05); the rate of caesarean section in two groups was 90% (208/231), 58.8% (30/51), and the difference was statistically significant (P0.05). Conclusion the pregnancy outcomes of three pregnant women were reduced to single pregnancy outcome ratio. The reduction to the twin is better, and the reduction to the single fetus does not increase the risk of abortion and reduces the rate of caesarean section; for three pregnant women, the advice or acceptance of pregnant women's opinions to a single pregnancy can better improve the pregnancy outcome.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R714.23

【参考文献】