Check J H, Nowroozi K, Vetter B, Rankin A, Dietterich C, Schubert B
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, New Jersey.
J Perinat Med. 1993;21(4):299-302. doi: 10.1515/jpme.1993.21.4.299.
A group of 32 women with at least 3 or more viable fetuses by sonography at approximately 8 weeks gestation were given the option of selective reduction. They were advised that this was a relatively new procedure but heretofore in a small series was not associated with a significant increase in fetal demise. Only 7 of 32 women chose this option. six of these 7 had triplets reduced to twins, 1 woman had quadruplets reduced to twins. Thirteen of 14 viable babies were successfully delivered at a mean of 36.8 weeks gestation; 2 of 7 (28.6%) delivered before 37 weeks. In contrast, 7 of 25 (24%) not having reduction lost all babies (6 triplets, 1 quadruplet). Four other women lost at least 1 of their gestations (total of 5 babies). Pre-term deliveries (< 37 weeks) occurred in 16 of 18 (88.8%) patients delivering at least 1 live baby, with a mean of 33.7 weeks gestation. Thus the high rate of total fetal loss and prematurity for multiple gestation and the low pregnancy wastage and pre-term delivery rate following selective reduction might make the latter a reasonable therapeutic option to patients interested in having the best chance of delivering healthy viable babies.
一组32名妇女，在妊娠约8周时经超声检查发现至少有3个或更多存活胎儿，她们可选择选择性减胎术。告知她们这是一种相对较新的手术，但迄今为止在一小系列病例中，并未发现胎儿死亡显著增加。32名妇女中只有7人选择了该手术。这7人中，6人将三胞胎减为双胞胎，1人将四胞胎减为双胞胎。14个存活胎儿中的13个在平均妊娠36.8周时成功分娩；7人中有2人（28.6%）在37周前分娩。相比之下，25名未进行减胎术的妇女中有7人（24%）失去了所有胎儿（6例三胞胎，1例四胞胎）。另外4名妇女至少有1次妊娠失败（共5个胎儿）。在至少分娩1个活婴的18名患者中，16人（88.8%）发生早产（<37周），平均妊娠33.7周。因此，多胎妊娠的胎儿总丢失率和早产率高，而选择性减胎术后的妊娠丢失率和早产率低，这可能使后者成为那些希望有最大机会分娩健康存活婴儿的患者的合理治疗选择。
