Manzur A, Goldsman M P, Stone S C, Frederick J L, Balmaceda J P, Asch R H
Department of Obstetrics and Gynecology, University of California, Irvine, Orange 92613-1491.
Fertil Steril. 1995 Feb;63(2):252-7. doi: 10.1016/s0015-0282(16)57350-6.
To assess the incidence of spontaneous embryo reduction as well as the obstetric and neonatal outcome of triplet gestations after assisted reproductive techniques (ART).
We analyzed the spontaneous outcome of 38 pregnancies in which three gestational sacs were identified with vaginal ultrasound between 21 and 28 days after ART. Weekly follow-up visits were scheduled during the first trimester until referral to a high-risk obstetrician. After delivery, each patient was interviewed individually and, if necessary, the obstetrician was contacted.
The triplets delivery rate was 47.4%, whereas 31.6% delivered twins, 18.4% delivered singletons, and only one patient miscarried all three cases (2.6%). Finding three fetal heart beats was associated with a triplet delivery rate of 69.2%, a twin incidence of 19.2%, and a singleton birth rate of 11.6%. Embryo resorptions were observed mainly during the first 7 weeks of gestation and did not occur beyond the 14th week. The mean gestational age at delivery and neonatal birth weight were significantly lower among triplets (32.8 weeks and 1,740 g versus 35.3 weeks and 2,352 g in twins and 39.1 weeks and 3,122 g for singletons). Triplets had a 100% prematurity and cesarean section rate compared with 67% and 75% in twins and 0% and 43% in singletons, respectively. Hospitalization at the Neonatal Intensive Care Unit was required in 83% of newborn triplets, 29% of twins, and 0% of singletons, with a mean stay of 34 and 21 days for triplets and twins, respectively. One stillbirth and no neonatal deaths were reported, with an overall perinatal mortality rate of 11.9 per 1,000.
Spontaneously, approximately 50% of triplet pregnancies will experience at least one embryo resorption. The ongoing triplets demand a complex and more expensive perinatal management, a strong argument to consider limiting the number of oocytes-embryos transferred in ART.
评估辅助生殖技术（ART）后三胎妊娠中自然胚胎减灭的发生率以及产科和新生儿结局。
我们分析了38例妊娠的自然结局，这些妊娠在ART后21至28天经阴道超声检查发现有三个妊娠囊。孕早期每周安排随访，直至转诊至高风险产科医生处。分娩后，对每位患者进行单独访谈，必要时联系产科医生。
三胎分娩率为47.4%，而双胎分娩率为31.6%，单胎分娩率为18.4%，仅有1例患者三胎均流产（2.6%）。发现三个胎心与三胎分娩率69.2%、双胎发生率19.2%和单胎出生率11.6%相关。胚胎吸收主要发生在妊娠的前7周，14周后未发生。三胎分娩时的平均孕周和新生儿出生体重显著低于双胎（三胎为32.8周和1740克，双胎为35.3周和2352克，单胎为39.1周和3122克）。三胎早产率和剖宫产率均为100%，而双胎分别为67%和75%，单胎分别为0%和43%。83%的三胎新生儿、29%的双胎新生儿需要入住新生儿重症监护病房，三胎和双胎的平均住院时间分别为34天和21天。报告1例死产，无新生儿死亡，围产儿总死亡率为每1000例11.9例。
自然情况下，约50%的三胎妊娠会发生至少一次胚胎吸收。持续存在的三胎需要复杂且费用更高的围产期管理，这有力地支持了在ART中考虑限制移植卵母细胞 - 胚胎数量的观点。
