本文選題：妊娠 + 三胎�。� 參考：《山東大學(xué)》2015年碩士論文

【摘要】：目的探討對三胎妊娠孕婦實施減胎術(shù)后雙胎或單胎的妊娠結(jié)局及流產(chǎn)率、母體妊娠期高血壓疾病、妊娠期糖尿病的發(fā)生風(fēng)險的分析。方法收集2001年9月—2014年3月在山東大學(xué)附屬省立醫(yī)院婦產(chǎn)科實施減胎術(shù)的282例三胎妊娠孕婦(其中自然受孕11例,其余均為輔助生殖技術(shù)助孕(assisted reproductive technologies, ART)),根據(jù)保留胎兒數(shù)目分成由三胎妊娠減至雙胎者231例(雙胎組)；由三胎妊娠減至單胎者51例(單胎組)。雙胎組因胎兒畸形和孕婦要求減至雙胎；單胎組因孕婦要求和雙絨毛膜三羊膜囊三胎妊娠(DCTA)減至單胎。在282例三胎妊娠中,口服促排卵藥物共37.2%(105/282),IVF-ET共58.9%(166/282),自然受孕共3.9%(11/282)。兩組孕婦減胎時平均孕周為(14.9±2.6)周,孕周范圍為(11.6-22.5)周。孕婦平均年齡(29.73±4.23)歲。本研究采用目標(biāo)胎兒心內(nèi)注射氯化鉀(potassium chloride, KCL)法減胎術(shù)。分析兩組妊娠結(jié)局、妊娠結(jié)束孕周、新生兒出生體質(zhì)量、母體妊娠期糖尿病(gestational diabetes mellitus, GDM)、妊娠期高血壓疾病患病率等。至少1個新生兒存活為妊娠成功；GDM、妊娠期高血壓疾病診斷標(biāo)準(zhǔn),參考我國衛(wèi)生部分別于2011、2012年發(fā)布的行業(yè)標(biāo)準(zhǔn)；結(jié)果1.總?cè)焉锍晒β蕿?1.5%(258/282),雙胎組新生兒總數(shù)為413例,除去4例死亡新生兒,新生兒存活409例,妊娠成功率為90.5%(209/231)；單胎組新生兒總數(shù)為49例,除去2例孕中期流產(chǎn),妊娠成功率為96.1%(49/51),兩組新生兒存活率比較,差異無統(tǒng)計學(xué)意義(P0.05)。2.雙胎組減胎時平均孕周為(16.5±3.5)周,單胎組為(14.2±2.0)周,將減胎孕周分為孕11-13周“、孕14-16周+6、≥17孕周3個時段,雙胎組減胎孕婦分別為129例(55.8%,129/231)、50例(21.6%,50/231)、52例(22.5%,52/231)；單胎組減胎孕婦分別為27例(52.9%,27/51)、16例(31.4%,16/51)、8例(15.7%,8/51),兩組不同減胎孕周時段的孕婦數(shù)比較,差異均無統(tǒng)計學(xué)意義(P0.05)。3.雙胎組孕11～13周+6、孕14-16周“、≥17孕周流產(chǎn)率分別為7.0%(9/129)、12.0%(6/50)、9.6%(5/52)；單胎組分別為3.7%(1/27)、0(0/16)、1/8,兩組不同孕周流產(chǎn)率分別比較,差異均無統(tǒng)計學(xué)意義(P0.05)。4.雙胎組和單胎組新生兒平均出生體質(zhì)量分別為(2 555±447)及(3 084±550)g, 兩組比較,差異有統(tǒng)計學(xué)意義(P0.05)；雙胎組及單胎組低出生體質(zhì)量兒(2 499 g)分別為45.5%(188/413)及8.2%(4/49),兩組差異有統(tǒng)計學(xué)意義(P0.05)；雙胎組極低出生體質(zhì)量兒(1499 g)發(fā)生率3.9%(16/413)與單胎組0(0/49)比較,差異無統(tǒng)計學(xué)意義(P0.05)。雙胎組孕婦231例中202例已正常分娩,其中雙胎體質(zhì)量生長不一致(出生體質(zhì)量相差15%-19%和≥20%)分別占12.4%(25/202)及15.3%(31/202)。5.雙胎組孕婦平均分娩孕周為(36.2±2.4)周,單胎組孕婦平均分娩孕周為(38.3±2.2)周,兩組比較,差異有統(tǒng)計學(xué)意義(P0.05)。對兩組孕婦孕34～36周+6及≥37周的分娩率分別進行比較,差異均有統(tǒng)計學(xué)意義(P0.05)。雙胎組孕婦足月分娩率為47.6%(110/231),單胎組為88.2%(45/51),兩組比較,差異有統(tǒng)計學(xué)意義(P0.05)。雙胎組孕婦28孕周的流產(chǎn)率為8.7%(20/231),單胎組為3.9%(2/51),兩組比較,差異無統(tǒng)計學(xué)意義(P0.05)。6.妊娠期高血壓疾病以及GDM在282例三胎妊娠減胎病例中總的發(fā)病率分別為8.9%(25/282)、4.6%(13/282)；母體發(fā)生妊娠期高血壓患病率在雙胎組、單胎組分別為10.4%(24/231)、2.0%(1/51),盡管兩組無明顯差異(P0.05)但是雙胎組比單胎組母體妊娠期高血壓疾病患病率增高；妊娠期糖尿病在二組的比例分別為4.8%(11/231)、3.9%(2/51),相差不大,但統(tǒng)計學(xué)無明顯意義(P0.05)；兩組剖宮產(chǎn)率分別為90.0%(208/231)、58.8%(30/51),差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論三胎妊娠孕婦經(jīng)減胎術(shù)減至單胎的妊娠結(jié)局比減至雙胎者更好,減至單胎者并沒有增加流產(chǎn)的發(fā)生風(fēng)險,降低了剖宮產(chǎn)率；對于三胎妊娠可建議或接受孕婦的意見減至單胎以更好改善妊娠結(jié)局。
[Abstract]:Objective to investigate the pregnancy outcome and abortion rate, maternal pregnancy induced hypertension and the risk of gestational diabetes in three pregnant women with pregnancy reduction, and to collect 282 cases of three pregnant women from September 2001 to March 2014 in the obstetrics and Gynecology Department of the affiliated Provincial Hospital of Shandong University. There were 11 cases of pregnancy, and the rest were assisted reproductive technology (assisted reproductive technologies, ART). According to the number of retained fetuses, 231 cases (double fetus) were reduced from three pregnancy to double fetus; 51 cases (single fetus) were reduced from three fetal pregnancy to single fetus. The three fetal pregnancy (DCTA) and double chorionic membrane sac were reduced to single fetus. In 282 cases of three pregnancy, oral administration of ovulation was 37.2% (105/282), IVF-ET was 58.9% (166/282), and natural pregnancy was 3.9% (11/282). The average pregnancy weeks in two groups of pregnant women were (14.9 + 2.6) weeks and the range of pregnancy was (11.6-22.5) weeks. The average age of pregnant women was (29.73 + 4.23) years. This study was studied in this study. Two groups of pregnancy outcomes, pregnancy end pregnancy, neonatal birth body mass, maternal gestational diabetes (gestational diabetes mellitus, GDM), pregnancy induced hypertension disease rate, etc. were analyzed in two groups of pregnancy outcomes, pregnancy end pregnancy, maternal gestational diabetes (GDM), and pregnancy induced hypertension. At least 1 newborns survived pregnancy success; GDM, pregnancy. The criteria for diagnosis of hypertension, refer to the industry standard published in 20112012 years in China's health section. Results the total success rate of 1. pregnancy was 91.5% (258/282), and the total number of newborn infants in the double fetus group was 413, 4 newborn babies, 409 newborns and 90.5% (209/231) pregnancy success rate; the total number of newborns in the single fetus group was 49, except 2. The successful rate of pregnancy was 96.1% (49/51). There was no significant difference in the survival rate between the two groups (P0.05). The average pregnancy week was (16.5 + 3.5) weeks (16.5 + 3.5) weeks, and the single fetus group was (14.2 + 2) weeks, and the gestational weeks were divided into 11-13 weeks, 14-16 weeks of pregnancy and 3 periods of more than 17 gestational weeks, and the pregnant women in the double fetus group were respectively (129 cases). 55.8%, 129/231), 50 cases (21.6%, 50/231), 52 cases (22.5%, 52/231), 27 cases (52.9%, 27/51), 16 cases (31.4%, 16/51), 8 cases (15.7%, 8/51) in single fetus group, and there was no statistical significance (P0.05).3. double fetus 21.6% weeks, 21.6% weeks of pregnancy. 0% (9/129), 12% (6/50), 9.6% (5/52), single fetus 3.7% (1/27), 0 (0/16), 1/8, two groups, the difference was not statistically significant (P0.05) the average birth weight of the twins and the single fetus group were (2555 + 447) and (3084 + 550) g respectively, and the difference was statistically significant (P0.05) in the two group (P0.05). The low birth weight infants (2499 g) were 45.5% (188/413) and 8.2% (4/49) respectively, and the two groups were statistically significant (P0.05). The incidence of extremely low birth weight (1499 g) in double fetus group was 3.9% (16/413) and 0 (0/49) of single fetus group (P0.05). In the double fetus group, 202 cases of pregnant women in 231 cases had normal childbirth, of which twins were twins. The inconsistency of body mass growth (15%-19% and > 20%) was 12.4% (25/202) and 15.3% (31/202).5. twins, respectively (36.2 + 2.4) weeks, and the average pregnancy weeks were (38.3 + 2.2) weeks in single fetus group. The difference was statistically significant (P0.05) in two groups (P0.05). The scores of 34~36 weeks +6 and more than 37 weeks of pregnant women in two groups of pregnant women were divided. The rate of delivery was statistically significant (P0.05). The full term delivery rate was 47.6% (110/231) and 88.2% (45/51) in the single fetus group. The difference between the two groups was statistically significant (P0.05). The abortion rate of the pregnant women in the twins group was 8.7% (20/231), and the single fetus group was 3.9% (2/51). The two groups were not statistically significant (P0.05).6.. The total incidence of pregnancy induced hypertension and GDM in 282 cases of three pregnancy reduction was 8.9% (25/282) and 4.6% (13/282). The incidence of hypertension in pregnant women was 10.4% (24/231) and 2% (1/51) in the single fetus group, although there was no significant difference between the two groups (P0.05), but the double fetus group was higher than the single fetus during pregnancy. The prevalence of pressure disease increased; the proportion of gestational diabetes in the two groups was 4.8% (11/231) and 3.9% (2/51), but the difference was not significant (P0.05); the rate of caesarean section in two groups was 90% (208/231), 58.8% (30/51), and the difference was statistically significant (P0.05). Conclusion the pregnancy outcomes of three pregnant women were reduced to single pregnancy outcome ratio. The reduction to the twin is better, and the reduction to the single fetus does not increase the risk of abortion and reduces the rate of caesarean section; for three pregnant women, the advice or acceptance of pregnant women's opinions to a single pregnancy can better improve the pregnancy outcome.
【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】：2015
【分類號】：R714.23

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相關(guān)期刊論文 前1條

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本文編號：1925756