连续100例多胎妊娠中选择性终止异常胎儿的病例。

One hundred consecutive cases of selective termination of an abnormal fetus in a multifetal gestation.

作者信息

Berkowitz R L, Stone J L, Eddleman K A

机构信息

Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, New York, USA.

出版信息

Obstet Gynecol. 1997 Oct;90(4 Pt 1):606-10. doi: 10.1016/s0029-7844(97)00312-8.

DOI:10.1016/s0029-7844(97)00312-8

PMID:9380324

Abstract

OBJECTIVE

To determine whether transabdominal selective termination of one or more abnormal fetuses in a multifetal pregnancy with dichorionic placentation is a safe and effective procedure.

METHODS

One hundred consecutive selective termination procedures were performed by transabdominal injection of potassium chloride into the heart or umbilical vein of an anomalous fetus in a multifetal pregnancy. All of the abnormal fetuses were presumed to have dichorionic diamniotic placentas, based on an ultrasound evaluation before the procedure. Follow-up data were obtained for each patient regarding the development of postprocedural complications, laboratory or clinical evidence of a coagulopathy, maternal or neonatal morbidity, gestational age at delivery, and birth weight of the infants.

RESULTS

Ninety-one sets of twins were reduced to singletons, six sets of triplets were reduced to twins, two sets of triplets were reduced to singletons, and one set of quadruplets was reduced to triplets. The anomalous fetus or fetuses were identified correctly and terminated in each case. Three patients spontaneously aborted, and one women electively terminated her pregnancy 2 weeks after the procedure. The mean gestational age at delivery of the 96 patients who delivered surviving infants was 36.8 weeks, and 85.4% delivered at 32 weeks or later. Three women developed laboratory evidence of a coagulopathy, but there were no cases of clinically evident disseminated intravascular coagulation.

CONCLUSION

This procedure, performed at a single institution by a small number of operators using a common protocol, accomplished its objective in all cases, was accompanied by a low spontaneous loss rate, and resulted in the birth of healthy infants at or near term in the vast majority of cases. This series suggests that selective termination is a reasonable option to consider when one abnormal fetus is found in a multifetal pregnancy with dichorionic placentation.

摘要

目的

确定经腹选择性终止双绒毛膜多胎妊娠中一个或多个异常胎儿是否为安全有效的操作。

方法

对连续100例多胎妊娠中异常胎儿经腹向心脏或脐静脉注射氯化钾进行选择性终止操作。根据操作前的超声评估，所有异常胎儿均推测为双绒毛膜双羊膜胎盘。获取每位患者关于术后并发症发生情况、凝血功能障碍的实验室或临床证据、孕产妇或新生儿发病率、分娩时的孕周以及婴儿出生体重的随访数据。

结果

91组双胞胎减为单胎，6组三胞胎减为双胞胎，2组三胞胎减为单胎，1组四胞胎减为三胞胎。每例均正确识别并终止了异常胎儿。3例患者自然流产，1例妇女在操作后2周选择性终止妊娠。96例分娩存活婴儿患者的平均分娩孕周为36.8周，85.4%在32周或更晚分娩。3例妇女出现凝血功能障碍的实验室证据，但无临床明显的弥散性血管内凝血病例。