Yovel I, Yaron Y, Amit A, Botchan A, David M P, Peyser M R, Lessing J B
Tel Aviv Sourasky Medical Centre, Serlin Maternity Hospital, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Hum Reprod. 1992 Sep;7(8):1173-5. doi: 10.1093/oxfordjournals.humrep.a137816.
A total of 30 patients with multifetal pregnancies, all resulting from treatment with superovulatory agents or assisted reproductive techniques, underwent embryo reduction. All patients had three or more fetuses (one sextuplet, two quintuplets, seven quadruplets and 20 triplets). The procedure was carried out using intra-embryonal injection of 0.9% sodium chloride solution. Embryo reduction was carried out via the transabdominal approach in 10 patients, performed at 11-12 weeks of gestation, and via the transvaginal route in 20 other patients, at 8-10 weeks of gestation. In the transabdominal group, one patient aborted following repeated attempts at embryo reduction while the other nine gave birth to healthy newborns (eight twins and one triplet). In the transvaginal group, four pregnancies are currently ongoing (all beyond 28 weeks of gestation), 14 pregnancies resulted in a delivery of at least one live newborn (13 twins and one singleton), one patient had a late abortion at 24 weeks' gestation and another was delivered at 27 weeks' gestation due to severe pre-eclampsia. Transvaginal ultrasound-guided needle procedures are commonly practised in most in-vitro fertilization units. The employment of this route for embryo reduction, performed at an earlier gestational age and with the use of a non-toxic substance such as 0.9% saline solution, is advocated.
共有30例多胎妊娠患者接受了减胎术，这些妊娠均由超排卵药物治疗或辅助生殖技术所致。所有患者均怀有三个或更多胎儿（1例六胞胎、2例五胞胎、7例四胞胎和20例三胞胎）。手术采用向胚胎内注射0.9%氯化钠溶液的方法进行。10例患者经腹途径进行减胎术，手术在妊娠11 - 12周时进行；另外20例患者经阴道途径进行减胎术，手术在妊娠8 - 10周时进行。经腹组中，1例患者在多次尝试减胎术后流产，另外9例产下健康新生儿（8例双胞胎和1例三胞胎）。经阴道组中，目前有4例妊娠仍在继续（均超过妊娠28周），14例妊娠至少分娩出1例活产新生儿（13例双胞胎和1例单胎），1例患者在妊娠24周时晚期流产，另1例因重度子痫前期在妊娠27周时分娩。经阴道超声引导下穿刺操作在大多数体外受精单位普遍应用。提倡在妊娠早期采用此途径进行减胎术，并使用无毒物质如0.9%生理盐水溶液。
