Bollen N, Camus M, Tournaye H, Wisanto A, Van Steirteghem A C, Devroey P
Centre for Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Belgium.
Fertil Steril. 1993 Sep;60(3):504-9. doi: 10.1016/s0015-0282(16)56168-8.
To evaluate pregnancy outcome after selective embryo reduction by transcervical aspiration or transvaginal puncture and intrathoracal injection with potassium chloride (KCl) in triplet pregnancies occurring after assisted procreation and to compare this outcome with that for triplets not undergoing embryo reduction.
Retrospective case series.
In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution.
Seventy-two patients presenting a triplet pregnancy after assisted procreation.
Transcervical aspiration embryo reduction at 8 to 9 weeks of pregnancy or transvaginal puncture and intrathoracal injection of KCl at 9 to 10 weeks of pregnancy.
Rate of spontaneous embryo reduction, complications relating to the procedure, pregnancy, and neonatal outcome.
The rate of spontaneous reduction was 18%. Among the 14 patients undergoing transcervical aspiration, 3 aborted and 4 lost an additional fetus. The transvaginal puncture technique had a lower complication rate (2/19). Neonatal outcome was improved in pregnancies after selective embryo reduction. After transvaginal puncture, the outcome was comparable with that for twin pregnancies after assisted procreation.
Triplet pregnancies after assisted procreation had a poor neonatal outcome. The outcome was improved after spontaneous reduction. Transcervical aspiration should not be used because of its high rate of early and late complications. Transvaginal puncture had less early complications, but the technique might be associated with prematurity and third trimester fetal death. In triplet pregnancies, embryo reduction decreases the number of babies going home per patient, but the quality of life of the remaining babies is improved.
评估在辅助生殖后发生的三胎妊娠中，经宫颈抽吸或经阴道穿刺并胸腔内注射氯化钾（KCl）进行选择性减胎后的妊娠结局，并将该结局与未进行减胎的三胎妊娠结局进行比较。
回顾性病例系列研究。
比利时布鲁塞尔自由大学荷兰语区生殖医学中心的体外受精项目，该中心为三级转诊机构。
72例辅助生殖后出现三胎妊娠的患者。
在妊娠8至9周时经宫颈抽吸减胎，或在妊娠9至10周时经阴道穿刺并胸腔内注射KCl。
自然减胎率、与操作相关的并发症、妊娠及新生儿结局。
自然减胎率为18%。在14例行经宫颈抽吸减胎的患者中，3例流产，4例又有1个胎儿丢失。经阴道穿刺技术的并发症发生率较低（2/19）。选择性减胎后的妊娠新生儿结局得到改善。经阴道穿刺后，结局与辅助生殖后的双胎妊娠相当。
辅助生殖后的三胎妊娠新生儿结局较差。自然减胎后结局得到改善。不应使用经宫颈抽吸，因为其早期和晚期并发症发生率高。经阴道穿刺早期并发症较少，但该技术可能与早产和孕晚期胎儿死亡有关。在三胎妊娠中，减胎减少了每位患者带回家的婴儿数量，但剩余婴儿的生活质量得到了改善。
