Ibérico G, Navarro J, Blasco L, Simón C, Pellicer A, Remohí J
Instituto Valenciano de Infertilidad (IVI), Valencia, Spain.
Hum Reprod. 2000 Oct;15(10):2228-33. doi: 10.1093/humrep/15.10.2228.
First-trimester transvaginal embryo reduction is an effective alternative for the management of multifetal pregnancy in assisted reproduction. We have modified the transvaginal technique by performing an intracardiac embryo puncture until asystolia is verified, without the injection of any substances. Any aspiration of embryo tissues or amniotic fluid was avoided. A total of 149 multifetal pregnancies was reduced to twins (n = 134) or singletons (n = 15) at early gestational age (7.8 +/- 0.8 weeks). Eleven cases (7.3%) of miscarriage, two cases (1.3%) of chorioamnionitis, and 17 cases (11.4%) of transient spotting were recorded as postoperative complications. Vanishing of one embryo occurred in four cases (3.0%) of those reduced to twins. The baby take-home rate was 89.5% for twins and 80.0% for singletons. Pregnancy outcome was analysed and compared with a control group of women with non-reduced multiple pregnancies. The birth weight of singleton pregnancies after reduction was lower (2929 +/- 160 versus 3291 +/- 422 g; P < 0.02). These studies show that early transvaginal intracardiac embryo puncture is an effective and safe technique.
孕早期经阴道胚胎减灭术是辅助生殖中多胎妊娠管理的一种有效替代方法。我们对经阴道技术进行了改良，即进行心内胚胎穿刺直至确认心脏停搏，且不注射任何物质。避免抽吸胚胎组织或羊水。共有149例多胎妊娠在孕早期（7.8±0.8周）减为双胎（n = 134）或单胎（n = 15）。记录到术后并发症包括11例（7.3%）流产、2例（1.3%）绒毛膜羊膜炎和17例（11.4%）短暂性阴道出血。减为双胎的病例中有4例（3.0%）出现一个胚胎消失。双胎的婴儿抱回家率为89.5%，单胎为80.0%。分析了妊娠结局并与未减胎的多胎妊娠女性对照组进行比较。减胎后单胎妊娠的出生体重较低（2929±160 vs 3291±422 g；P < 0.02）。这些研究表明，早期经阴道心内胚胎穿刺是一种有效且安全的技术。
