Coffler M S, Kol S, Drugan A, Itskovitz-Eldor J
Department of Obstetrics and Gynecology, Rambam Medical Center, POB 9602, Haifa 31096 and Faculty of Medicine, Technion, Israel Institute of Technology, Israel.
Hum Reprod. 1999 Jul;14(7):1875-8. doi: 10.1093/humrep/14.7.1875.
Assisted reproduction technologies and ovulation induction for treatment of infertility continue to cause high order multiple gestations. Increased perinatal morbidity and mortality, as well as maternal morbidity, may complicate these pregnancies. Selective fetal reduction, an acceptable therapeutic approach in these cases, is usually performed at or after the ninth week of gestation, with KCl injected in the vicinity of the fetal heart, and is associated with a total pregnancy loss rate of 11.7%. We report our experience with 90 women who underwent early (mean 7.5 weeks gestation, range 7. 0-8.0 weeks) transvaginal selective embryo aspiration. The mean number of viable embryos before and after reduction was 3.5 and 2.1 respectively. Six (6.7%) pregnancies were lost before 24 gestational weeks. One miscarriage occurred at the tenth gestational week. The other five pregnancies were aborted at 17.3-21.6 weeks gestation. Additional interventions were performed in three of these pregnancies: genetic amniocentesis in two cases and cervical suture in one case. In the subset of 39 patients with>/=4 embryos, only one (2.6%) pregnancy loss was recorded. This loss rate is significantly lower (P < 0.05) than the 15.3% loss rate in patients with >/=4 fetuses calculated from other work. Four (4.4%) other pregnancies were complicated by premature delivery (25-28 weeks gestation). Mean gestational age of delivered pregnancies in our series was 35.7 weeks. In conclusion, early transvaginal embryo aspiration is a simple and relatively safe method for multiple pregnancy reduction. The overall pregnancy loss rate associated with early embryo aspiration is similar to that of procedures performed at later gestational age, but is significantly lower when the initial number of embryos is four or greater.
辅助生殖技术及促排卵治疗不孕症仍会导致多胎妊娠。围产期发病率和死亡率增加以及孕产妇发病可能使这些妊娠复杂化。选择性减胎术是这些情况下可接受的治疗方法，通常在妊娠9周及以后进行，将氯化钾注入胎儿心脏附近，其总妊娠丢失率为11.7%。我们报告了90例接受早期（平均妊娠7.5周，范围7.0 - 8.0周）经阴道选择性胚胎抽吸术的妇女的经验。减胎术前和术后存活胚胎的平均数量分别为3.5个和2.1个。6例（6.7%）妊娠在妊娠24周前丢失。1例流产发生在妊娠第10周。其他5例妊娠在妊娠17.3 - 21.6周时流产。其中3例妊娠进行了额外干预：2例行遗传羊膜穿刺术，1例行宫颈缝合术。在39例有≥4个胚胎的患者亚组中，仅记录到1例（2.6%）妊娠丢失。该丢失率显著低于（P < 0.05）根据其他研究计算出的有≥4个胎儿患者15.3%的丢失率。另外4例（4.4%）妊娠并发早产（妊娠25 - 28周）。我们系列中分娩妊娠的平均孕周为35.7周。总之，早期经阴道胚胎抽吸术是一种简单且相对安全的多胎妊娠减胎方法。与早期胚胎抽吸术相关的总体妊娠丢失率与妊娠晚期进行的手术相似，但当最初胚胎数量为4个或更多时显著更低。
