【摘要】 目的:分析年龄、减胎孕周、减胎数量、保留胎儿数量对多胎妊娠药物选择性减胎术后妊娠结局的影响。方法:回顾性分析2016～2019年于山东省妇幼保健院行多胎妊娠药物选择性减胎术的患者416例，随访至本次妊娠结束，其中流产28例，早产114例，足月产274例。采用单因素及多分类Logistic回归分析妊娠年龄、减胎孕周、被减胎儿数量、保留胎儿数量与不良妊娠结局(早产及流产)的关系；并对孕周<34周早产组(41例)与孕周≥34周早产组(73例)在以上相关因素中的发生占比进行比较。结果:(1)单因素分析示：行药物选择性减胎术时保留不同胎儿数量的孕妇，术后流产率、早产率及足月产率的比较，差异有统计学意义(P<0.05)。减胎时孕妇年龄、减胎孕周和被减胎数量不同，术后孕妇妊娠结局比较，差异均无统计学意义(P>0.05)。(2)多分类Logistic回归分析示：减胎时年龄、减胎孕周和保留胎儿数量对术后孕妇的不良妊娠结局有影响，其中年龄≥40岁、减胎孕周≥14周和保留胎儿数量≥2胎是减胎术后发生早产的独立危险因素(OR>1,P<0.05),而年龄30～35岁、年龄≥40岁和保留胎儿数量≥2胎是减胎术后导致流产的独立危险因素(OR>1,P<0.05)。(3)孕周<34周与孕周≥34周早产孕妇间不同年龄段的比较，差异有统计学意义(P<0.05),其中孕周<34周孕妇中年龄<30岁的占比(56.1%)高于孕周≥34周孕妇(32.9%)。结论:被减胎儿数量不是减胎术后发生不良妊娠结局的危险因素，术前的评估指标更应该关注孕妇年龄、减胎时孕周、保留胎儿的数量；年龄<30岁的患者行多胎妊娠药物选择性减胎术应尽量避免早期早产的发生。更多还原

【Abstract】 Objective:To analyze the effects of maternal age, gestational weeks of fetal reduction, number of fetal reduction, number of reduced fetuses and number of reserved fetuses on the pregnancyoutcome after drugselective reduction inmultiple pregnancies.Methods:Retrospective analysis was performed on 416 cases of selective multiple pregnancy reduction in Maternal and Child Health Care Hospital of Shandong Province from 2016 to 2019.Follow up until the end of this pregnancy, including 28 cases of abortion, 114 cases of premature delivery and 274 cases of full-term delivery.Univariate and multi-categorical Logistic regression analysis was used to analyze the relationship betweenmaternalage, gestational ageatreduction, number of reduced fetuses, number of preserved fetuses and adverse pregnancy outcomes.The incidence of preterm birth at<34 weeks of gestation(n=41) and≥34 weeks of gestation(n=73) in the above related factors were compared.Results:(1)Univariate analysis showed that there were significant differences in abortion rate, preterm birth rate and term birth rate among pregnant women with different number of fetuses retained during drug selective fetal reduction(P<0.05).Whenmaternal age, gestational age and number of reduced fetuses were different at the time of reduction, there was no significant difference in pregnancy outcome after operation(P>0.05).(2)Multi-classification Logistic regression analysis showed thatmaternal age, gestational age and number of preserved fetuses at the time of fetal reduction had an impact on adverse pregnancy outcomes.Among them, maternal age≥40 years, gestational age≥14 weeks and number of preserved fetuses≥2 were independent risk factors for preterm birth after fetal reduction(OR>1,P<0.05).Maternal age between 30-35 years old, ≥40 years old and number of retained fetuses≥2 were independent risk factors for abortion after fetal reduction(OR>1,P<0.05).(3)There were significant differences in age groups between the<34 weeks of gestation and the≥34 weeks of gestation(P<0.05).The proportion of age<30 years in the<34 weeks of gestation(56.1%) was higher than that in the≥34 weeks of gestation(32.9%).Conclusions:The number of reduced fetuses is not a risk factor for adverse pregnancy outcomes after reduction.Preoperative assessment should focus on maternal age, gestational age at reduction and the number of retained fetuses.Early preterm labor should be avoided in patients under 30 years of age undergoing multiple pregnancy reduction.更多还原