Timor-Tritsch I E, Peisner D B, Monteagudo A, Lerner J P, Sharma S
Department of Obstetrics and Gynecology, Sloane Hospital for Women, Columbia Presbyterian Medical Center, New York, NY.
Am J Obstet Gynecol. 1993 Mar;168(3 Pt 1):799-804. doi: 10.1016/s0002-9378(12)90823-6.
This report reviews multifetal pregnancy reductions performed transvaginally and tests the feasibility and associated pregnancy loss rates with this technique.
One hundred thirty-four consecutive multifetal pregnancy reductions were analyzed regarding different aspects of total pregnancy losses and complications. The first 40 manually performed were compared with the last 94 procedures performed with an automated puncture device and a thin needle. The losses were also analyzed as a comparison of the reduction of the lower-lying with the higher-lying fetuses located in relation to the internal os.
A total uncorrected total pregnancy loss rate of 12.6% and a corrected loss rate of 10.6% was observed. Of the 112 pregnancies in which the lower-lying fetus was reduced, 11 losses were seen. The loss rate in the group reducing the upper fetus was three of 22. The manual versus the puncture device groups showed the same loss rate (10%); however, the manual group had a larger number of subchorionic hematomas after the procedure.
The data are indicative of a very low maternal complication rate (infection) and an acceptable loss rate of the entire pregnancy. The loss rates compare favorable with those for multifetal pregnancy reduction performed transabdominally.
本报告回顾经阴道进行的多胎妊娠减胎术，并测试该技术的可行性及相关的妊娠丢失率。
分析了连续134例多胎妊娠减胎术的全妊娠丢失和并发症的不同方面。将最初手动操作的40例与最后使用自动穿刺装置和细针操作的94例进行比较。还将低位胎儿与相对于子宫内口位置较高的胎儿减胎后的丢失情况进行分析比较。
观察到总的未校正妊娠丢失率为12.6%，校正后丢失率为10.6%。在112例减胎低位胎儿的妊娠中，有11例发生丢失。减胎高位胎儿的组中，22例中有3例发生丢失。手动操作组与穿刺装置组的丢失率相同（10%）；然而，手动操作组术后绒毛膜下血肿较多。
数据表明母体并发症率（感染）非常低，整个妊娠的丢失率可接受。该丢失率与经腹进行的多胎妊娠减胎术的丢失率相比有利。
