Analysis Of Pregnancy Outcome And Related Influencing Factors After Multiple Reductiong

Objective:To analyze the effects of pregnant women’s age,gestational age of reduction,mode of conception,number of reduced fetus,number of retained fetus,reason of reduction,route of reduction and other factors on pregnancy outcome after multiple reduction,and looking for advantages to reduce gestational weeks.Methods:Clinical data of 223 pregnant women who underwent multiple reduction in Hebei Provincial People’s Hospital from February 2009 to July 2022 were retrospectively analyzed,including 201 cases of abdominal kcl reduction and 22 cases of vaginal reduction in the first trimester.The average age of 223 pregnant women was 30.1±4.5 years old.The minimum age was 20 years old and the maximum was 50 years old.The median gestational age of pregnancy reduction was 19⁺⁴（16,24）weeks,the minimum gestational age of pregnancy reduction was 6⁺³ weeks,and the maximum gestational age of pregnancy reduction was 36⁺¹ weeks.166 cases（74.4%）were DCDA;DCTA in 7 cases（3.1%）;41 cases（18.4%）of TCTA;8 cases（3.6%）had tetrachorionic amniotic sac.one case（0.4%）of pentachorionic pentamniotic sac.The influence of maternal age on pregnancy outcome after reduction was analyzed by oneway analysis of variance.KruskalWallis H rank sum test was used to analyze the effect of gestational age on pregnancy outcome after pregnancy reduction.Chisquare test or fisher’s precision probability test were used to analyze the effects of the number of initial/subtracted/retained fetuses,the mode of conception,and the causes of fetal reduction on the pregnancy outcome after fetal reduction.Chisquare test was used to analyze the difference of pregnancy outcomes after vaginal reduction in the first trimester and abdominal kcl reduction in the second and third trimester pregnant.Results:1.There were no statistically significant differences in the partus maturus rate,premature birth rate and abortion rate between the advanced maternal age group（age≥35 years old）and the nonadvanced maternal age group（age<35 years old）,There was also no statistical significance in different age,method of conception,or reason for pregnancy reduction（P>0.05）;2.There was no statistical significance in pregnancy outcomes of different initial fetal number and different number of reduced fetuses（P>0.05）.3.There were statistically significant differences in the pregnancy outcomes of different number of retained fetuses（P<0.05）.The partus maturus rate of one retained fetuses was higher（72.7%vs46.7%）,and the premature birth rate of two retained fetuses was higher（43.3%vs18.7%）.There was no statistical difference in pregnancy outcomes between twin pregnancy reduced to single and triplet pregnancy reduced to single,nor was there any statistical difference in pregnancy outcomes between triplet reduced to twin and quadruplet reduced to twin（P>0.05）.The fullterm rate of triplet reduction to single pregnancy is higher than triplet reduction to twin pregnancy（90.0%vs48.1%）,and the difference was statistically significant（P<0.05）.4.There was no significant difference in pregnancy outcome between vaginal aspiration and vaginal kcl reduction in early pregnancy（P>0.05）.5.The comparison between early pregnancy reduction（reduced gestational weeks<12 weeks）and five different groups of transabdominal kcl reduction gestational weeks(13～17⁺⁶ weeks,18～22⁺⁶ weeks,23～26⁺⁶ weeks,27～33⁺⁶ weeks,34～36⁺⁶ weeks)suggested that 18～22⁺⁶ weeks of pregnancy reduction,can obtain the highest partus maturus rate,the lowest rate of premature birth.Pregnancy reduction after 27 weeks of gestation was associated with a greater risk of premature birth.Pregnancy reduction at 13 to 17⁺⁶weeks of gestation was associated with the lowest abortion rate,and the highest abortion rate at the first trimester,with statistical significance（P<0.05）.Conclusions:1.The age of pregnant women,method of conception,reason for reduction of fetus,number of initial fetus and number of reduced fetus are not the key factors affecting the pregnancy outcome after peritoneal reduction of fetus.2.The pregnancy outcome after transabdominal kcl reduction is mainly affected by the number of preserved fetuses.One preserved fetus can obtain a higher partus maturus rate,while two preserved fetuses have a greater risk of premature birth.It is recommended that pregnant women with three pregnancies be reduced to single pregnancies for better pregnancy outcomes.3.In early pregnancy,vaginal aspiration reduction and vaginal kcl reduction can achieve similar pregnancy outcomes.4.The optimal gestational age of abatement is 18～22⁺⁶ weeks,which can obtain the highest partus maturus rate and the lowest premature birth rate.5.The rate of abatement abortion in early pregnancy is higher,and the fetal death in utero and developmental abnormalities may occur after pregnancy reduction,so it is not recommended to reduce pregnancy in early pregnancy.