孕早期减胎至单胎或双胎：与经腹绒毛取样减胎前最终胎儿数量及核型分析相关的结局

Brambati Bruno, Tului Lucia, Camurri Lamberto, Guercilena Stefano

Center of Prenatal Diagnosis, Viale Sabotino 28, 20135 Milan, Italy.

Am J Obstet Gynecol. 2004 Dec;191(6):2035-40. doi: 10.1016/j.ajog.2004.05.003.

OBJECTIVE

The purpose of this study was to evaluate fetal outcome and maternal complications of multifetal pregnancy reduction to a single fetus or twins. To evaluate safety and efficacy of transabdominal chorionic villus sampling for karyotyping before fetal reduction.

STUDY DESIGN

Four hundred twenty-four consecutive multiple pregnancies were reduced to twins (255 pregnancies) or a single fetus (169 pregnancies) at 8 to 13 weeks of gestation after transabdominal chorionic villus sampling for fetal karyotyping. Fetal and maternal outcome were observed prospectively and compared with control series of twin (147) and singleton (885) pregnancies in which reduction procedures were not performed.

RESULTS

Transabdominal chorionic villus sampling was performed successfully in 100% of the cases. The accuracy of karyotyping was 99.2%. The overall pregnancy loss rate after reduction was 3.3%. No differences were observed between study and control series for severe prematurity, low birth weight, and neonatal deaths. Mean gestational age at delivery (35.2% vs 38.1%) and mean birth weight (2180 g vs 2873 g) were significantly lower; preterm delivery (64% vs 11%), neonatal death (3.4% vs 0.6%), and maternal complications (42.8% vs 9.5%) were significantly higher when the reduction was to twins rather than in reduction to a single fetus. Pregnancy loss rate did not differ between study series. The overall rate of chromosomal abnormalities in the study series was higher (relative risk, 2.0) than in singleton control series.

CONCLUSION

The outcome of multiple pregnancies that were reduced to a single fetus or twins was similar to that of nonreduced pregnancies; fetal and maternal complications were significantly lower in the series of pregnancies that were reduced to a single fetus. The safety and efficacy of transabdominal chorionic villus sampling and the higher pregnancy rate of chromosomal abnormalities in multiple pregnancies imply that fetal karyotyping should be advised before fetal reduction.

目的

本研究旨在评估多胎妊娠减胎至单胎或双胎后的胎儿结局及母体并发症。评估经腹绒毛取样在减胎术前进行染色体核型分析的安全性和有效性。

研究设计

在经腹绒毛取样进行胎儿染色体核型分析后，于妊娠8至13周将424例连续多胎妊娠减胎为双胎（255例妊娠）或单胎（169例妊娠）。前瞻性观察胎儿和母体结局，并与未进行减胎术的双胎（147例）和单胎（885例）妊娠对照系列进行比较。

结果

所有病例经腹绒毛取样均成功完成。染色体核型分析的准确率为99.2%。减胎术后总体妊娠丢失率为3.3%。在严重早产、低出生体重和新生儿死亡方面，研究组与对照组之间未观察到差异。分娩时的平均孕周（35.2%对38.1%）和平均出生体重（2180克对2873克）显著较低；减胎至双胎时早产（64%对11%）、新生儿死亡（3.4%对0.6%）和母体并发症（42.8%对9.5%）显著高于减胎至单胎。研究系列之间的妊娠丢失率无差异。研究系列中染色体异常的总体发生率高于单胎对照系列（相对风险，2.0）。