本文選題：單卵三胎和四胎 + 發(fā)病機(jī)制　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：與單胎妊娠相比,多胎妊娠,特別是單卵多胎妊娠的母親和胎兒,發(fā)生妊娠相關(guān)并發(fā)癥的風(fēng)險和嚴(yán)重程度都會有不同程度的增加,造成不良妊娠結(jié)局。射頻減胎術(shù)已廣泛用于單絨毛膜雙胎妊娠的處理,但單卵三胎和四胎妊娠臨床非常罕見,而且其胎盤血.管吻合和胎盤份額分配更加復(fù)雜,因此對單卵三胎和四胎妊娠的孕婦施行選擇性減胎術(shù),其減胎方法和臨床結(jié)局仍需進(jìn)一步探討。本研究中我們就近年收治的8例單卵三胎和四胎妊娠的射頻減胎術(shù)病例進(jìn)行總結(jié),并對文獻(xiàn)報道進(jìn)行綜述,希望能對單卵三胎和四胎妊娠的臨床處理提供一定的借鑒。2014年3月至2017年1月,山東省立醫(yī)院產(chǎn)科共收治7例單卵三胎妊娠和1例單卵四胎妊娠病例。這8例病例妊娠年齡為24-34歲,患者均既往體健,無基礎(chǔ)疾病,孕早期順利,無腹痛及陰道流血等表現(xiàn)。6例自訴為自然妊娠,2例為IVF-ET術(shù)后妊娠,所有患者均無明顯多胎妊娠家族聚集現(xiàn)象。孕16-18周于我院行射頻減胎術(shù)。妊娠結(jié)局:7例最終成功分娩兩活嬰,均為剖宮產(chǎn)分娩,其中未足月胎膜早破早產(chǎn)2例,重度子癇前期早產(chǎn)1例,足月產(chǎn)4例;1例于減胎術(shù)后6天感染、流產(chǎn);新生兒出生1分鐘及5分鐘Apgar評分均在7分以上,3例接受住院治療,1例出現(xiàn)新生兒病理性黃疸,1例出現(xiàn)新生兒喉鳴,未見其他明顯異常;患者產(chǎn)后無相關(guān)并發(fā)癥發(fā)生,體健。雖然缺乏臨床對照,且樣本量較少,尚不能得出有關(guān)高序單卵多胎妊娠施行射頻減胎術(shù)的相關(guān)臨床結(jié)論,但從中可見,施行高序單卵多胎妊娠射頻減胎術(shù),能夠有效降低妊娠流產(chǎn)率、妊娠期合并癥發(fā)生率及圍產(chǎn)兒病死率,對于改善母嬰預(yù)后意義重大,且在技術(shù)上是可行的、安全的。單卵三胎和四胎妊娠自然發(fā)生率很低,近年來人工輔助生殖技術(shù)的廣泛使用,使得其發(fā)生率明顯升高,但具體機(jī)制尚不明確,可能與妊娠年齡、透明帶處理、卵巢刺激、胚胎培養(yǎng)時間和遺傳等多個因素相關(guān)。單卵三胎和四胎妊娠孕產(chǎn)婦出現(xiàn)流產(chǎn)、妊娠期高血壓疾病、選擇性胎兒生長受限、胎膜早破、胎兒宮內(nèi)窘迫、胎死宮內(nèi)、早產(chǎn)等風(fēng)險均不同程度增加。雙胎輸血綜合征是單卵多胎妊娠特征性的并發(fā)癥,施行減胎術(shù)和激光凝固術(shù)是有效的治療方法。
[Abstract]:Compared with single pregnancy, the risk and severity of pregnancy-related complications will increase in different degrees in multiple pregnancies, especially in mothers and fetuses of single ovum multiple pregnancies, resulting in adverse pregnancy outcomes. Radiofrequency minimization has been widely used in the management of single chorionic twin pregnancy, but the clinical practice of single egg triplet and four pregnancy is very rare, and its placental blood is very rare. Tube anastomosis and placental share distribution are more complicated. Therefore, the method and clinical outcome of selective fetal reduction for single triplets and four pregnancies need to be further explored. In this study, we summarized 8 cases of single ovum triplets and four pregnancies undergoing radiofrequency reduction, and reviewed the literature. From March 2014 to January 2017, a total of 7 cases of monozygotic triple pregnancy and 1 case of one-ovum four-embryo pregnancy were admitted to the Department of Obstetrics of Shandong Provincial Hospital. The gestational age of these 8 cases was 24-34 years old. All the patients were in good health, no underlying diseases, smooth early pregnancy, no abdominal pain and vaginal bleeding. 6 cases of spontaneous pregnancy were diagnosed as spontaneous pregnancy and 2 cases were pregnancy after IVF-ET. There was no significant family aggregation of multiple pregnancies in all patients. 16-18 weeks of gestation were performed in our hospital. At the end of pregnancy, 7 cases were successfully delivered by cesarean section, including 2 cases of premature rupture of unmatured membranes, 1 case of severe preeclampsia, 1 case of term delivery and 1 case of infection 6 days after fetal reduction. The Apgar scores at 1 and 5 minutes of birth were above 7 in 3 cases with neonatal pathological jaundice, 1 case with neonatal larynx and 1 case with no other obvious abnormality, and there were no related complications and physical health after delivery. Although there is a lack of clinical control and a small sample size, it is not possible to draw the relevant clinical conclusions about the application of radiofrequency fetal reduction in high-order single-ovulation multiple pregnancy, but it can be seen from the above that the high-order single-ovulation multiple pregnancy is performed with radiofrequency reduction. It can effectively reduce the rate of abortion of pregnancy, the incidence of complications of pregnancy and the perinatal mortality, which is of great significance to improve the prognosis of mother and child, and is technically feasible and safe. In recent years, the prevalence of artificial assisted reproduction technology has increased significantly, but the specific mechanism is not clear, which may be associated with pregnancy age, treatment of pellucida, ovarian stimulation, the incidence of pregnancy is very low, the use of artificial assisted reproductive technology in recent years, the incidence is significantly increased, but the specific mechanism is not clear. Embryo culture time and heredity are related to many other factors. The risk of abortion, hypertensive disorder complicating pregnancy, selective fetal growth restriction, premature rupture of membranes, fetal distress, fetal death and premature delivery increased in different degrees. Twin transfusion syndrome is a characteristic complication of single ovum multiple pregnancy.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.23

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