Characteristics and Birth Outcomes of Pregnant Women Treated with Corticosteroid after Fetal Reduction

背景和目的：腦性麻痺往往使嬰幼兒發展遲緩，若能早期發現、早期療育，可減緩其臨床表徵，避免帶給家庭及社會極大的負擔。相較於單胞胎，經多胚胎減胎之雙胞胎常有明顯的運動神經發育遲緩，特別易有腦性麻痺。在1997年，Pharoah等學者提出”Vanishing Twin Syndrome”，特別強調，由於此現象，極有可能是腦性麻痺的原因之一。其次，對於安胎的孕婦施行類固醇以利胎兒的肺部成熟行之有年，近幾年來，此種治療也陸續有人指出，對嬰兒神經的發育不良之影響。本次研究主要以前瞻性的調查，在多胚胎減胎的雙胞胎中使用類固醇的族群，其出聲預後之追蹤成果。方法：本次研究主要比較經多胚胎減胎的雙胞胎中，母親因早期宮縮而施打類固醇與無早期宮縮的對照族群，調查其出生之雙胞胎嬰兒，在腦性麻痺、先天性異常、平均出生體重、母親年紀、減胎時的週數是否有明顯的差異，樣本由新光醫院自西元1992年至2000年，共有94位由4胞胎減成雙胞胎的孕婦，其中使用類固醇的孕婦有38位為實驗組，另外56位為對照組。以SPSS10.0中文版套裝軟體進行統計：包括平均值、標準差、t檢定。結果：此94位孕婦，其所出生的雙胞胎皆存活並大於兩歲，生產方式皆為剖腹產，平均出生週數是實驗組32.4±2.7週，對照組為36.0±2.9週。平均胎兒出生體重實驗組2099±555公克，對照組2405±519公克。在腦性麻痺兒方面，僅實驗組有一位，其餘皆在正常之神經方面範圍。在比較此兩組資料，只有平均出生體重與生產週數有明顯差異，其餘皆無明顯差異。結論：嚴格限制胚胎的植入數,並且在經減胎後的雙胞胎孕婦方面，儘量延長新生兒的出生周數是必要的措施。

關鍵字

多胞減胎；類固醇治療；腦性麻痺；雙胞胎

並列摘要

Background and Purpose: Compared with singleton births, twin pregnancies are at increased risk of significant child morbidity, particularly cerebral palsy, after high-order fetal reduction. This is termed the vanishing-twin syndrome, and is an important etiology of cerebral palsy. Antenatal corticosteroid therapy (CCT) is widely used during preterm labor to enhance lung maturity. The use of dexamethasone, however, increases the risk for detrimental long-term neurodevelopmental effects. Thus, in this study we assess the effect of CCT on neurological disability and congenital abnormality in twins over 2 years of age after fetal reduction. Methods: The CCT (38 sets of twins) and control (56 sets) groups were compared for the incidences of cerebral palsy and congenital abnormalities, as well as mean birth weight, maternal age, and mean gestational age at delivery and at fetal reduction using records from Shin-Kong Memorial Hospital for the period 1992~2000. Results: There were 94 quadruplet-reduced sets of twins in our study. All of these twins were alive and aged over 2 years at the time of this writing. The gestational age at the time of delivery was 32.4±2.7 weeks for the CCT group vs. 36±2.9 weeks for the controls, with mean birth weights of 2099±555 vs. 2405±519g, respectively (p＜0.01). All 94 sets of twins were delivered by cesarean section, with only 1 case of cerebral palsy in the CCT group, while the others had developed normally by the age of 2 years. Only mean birth weight and gestational age at delivery showed significant differences in comparisons of the 2 groups of twins. Conclusion: Limiting the number of embryo transfers is essential for preventing adverse effects of the vanishing-twin syndrome. When reduction has been performed, a prolonged gestational age at delivery is mandatory for twin babies.

並列關鍵字

multifetal pregnancy reduction ； corticosteroid therapy ； cerebral palsy ； twin pregnancy

國際替代計量

Characteristics and Birth Outcomes of Pregnant Women Treated with Corticosteroid after Fetal Reduction

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