| ObjectiveMultifetal pregnancy reduction (MFPR)was developed in the mid-1980s whentheincidence of triplets and higher-order gestations was increasing exponentially as aresult of the expanded use of assistedreproductive technology (ART) and ovulation induction.The term MFPR refersto the process of reducing this higher-order multiple gestations to a singletonor twin pregnancy to mitigate the associated obstetricalcomplication and perinatal risks. Currently, pregnancy loss rate reported in the foreign countries has decreased to 4.7% and has remained for a very long time, but in developing countries this rate is higher. Given the fact that multifetal pregnancy reduction has achieved great improvements, we should realize that bad outcomes still take place after the procedure, for instance:preterm premature rupture, chorioamnionitis, placental abruption, etc. And these will bring catastrophes to families. To investigate and evaluate the risk factors of the adverse pregnancy outcomes after fetal reduction with multifetal patients.Methods68 cases with adverse pregnancy outcomes who received multi-fetal pregnancy reduction at Shandong provincial hospital affiliated to Shandong university were recruited from May 2004 to Sep 2015,another 136 cases with normal pregnancy outcomes were recruited as control. Datas including age, weight, method of pregnancy, the presence of vaginal bleeding, WBC count before reduction, total times of delivery, the starting number, reason of reduction, the number of reduction, pregnancy age of reduction, the reducing number of fetal, the keeping number of fetal, having penetrated placenta or not when operating reduction, times of penetration, having vaginitis or not before reduction, days of using antibiotic after reduction, were gathered from both groups during reduction. Statistic analysis were done between the two groups. Potassium chloride was injected into the targeted fetal heart or skull until cardiac standstill was obtained.Results(1) the mean age in group of the adverse pregnancy outcomes was 28.74±3.784, group of the normal pregnancy outcomes was 30.01±4.306, there was difference between the two groups(p<0.05);(2)The mean starting number in group of the adverse pregnancy outcomes was 3.38±1.037, group of the normal pregnancy outcomes was 3.00±0.779, there was difference of the starting number between the two groups(p<0.05);(3)the mean finishing number in group of adverse pregnancy outcomes was 1.81±0.580, group of the normal pregnancy outcomes was 1.62± 0.517, there was difference of the finishing number between the two groups(p<0.05). (4) The proportions of puncturing the placenta in group of the adverse pregnancy outcomes was 68.3%, the group of the normal pregnancy outcomes was 37.4%, there was difference of puncturing the placenta or not between the two groups(p<0.05);(5) the mean puncturing times in group of adverse pregnancy outcomes during reduction was 2.29±1.486, the group of the normal pregnancy outcomes was 1.85±1.050, there was difference between the two groups(p<0.05); (6)there were no differences of other factors between the two group(p>0.05); (7)Logistic regression analysis showed that puncturing the placenta or not was independent factor.Conclusions1. The starting number of fetus is less, the loss rate after multifetal reduction is lower.2. The finishing number of fetus is less, the loss rate after multifetal reduction is lower.3. The puncturing times are more, the loss rate after multifetal reduction is higher.4. Puncturing the placenta during the reduction can lead to the increasing loss rate after multifetal reduction. |
