Dodd J M, Crowther C A
Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, Australia.
Cochrane Database Syst Rev. 2003(2):CD003932. doi: 10.1002/14651858.CD003932.
When couples are faced with the dilemma of a higher order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses.
To assess a policy of multifetal reduction with a policy of expectant management of women with a triplet or higher order multiple pregnancy.
We searched the Cochrane Pregnancy and Childbirth Group trials register (30 September 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002), and PubMed (to 30 September 2002).
Randomized controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a triplet or higher order multiple pregnancy.
Two reviewers independently assessed trial quality and extracted data.
There were no randomised controlled trials identified.
REVIEWER'S CONCLUSIONS: There are insufficient data available to support a policy of pregnancy reduction procedures for women with a triplet or higher order multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures, reduction in the number of fetuses by selective termination may not been acceptable to women, especially for those with a past history of infertility. The acceptability of this option, and willingness to undergo randomisation will depend on the couple's social background and beliefs, and consequently, recruitment to such a trial may prove exceptionally difficult.
当夫妇面临高阶多胎妊娠的困境时，有三种选择。终止整个妊娠通常不为女性所接受，尤其是那些有过不孕史的女性。试图让所有胎儿继续妊娠会带来早产、存活及长期发病等固有问题。另一种选择是通过选择性终止妊娠来减少胎儿数量。这些选择对夫妇的可接受性将取决于他们的社会背景和基本信念。本综述聚焦于减少胎儿数量。
将多胎妊娠减胎术政策与三胎或更高阶多胎妊娠女性的期待管理政策进行评估比较。
我们检索了Cochrane妊娠与分娩组试验注册库（2002年9月30日）、Cochrane对照试验注册库（《Cochrane图书馆》，2002年第2期）以及PubMed（截至2002年9月30日）。
报告了相关数据的随机对照试验，比较期待管理的母亲和婴儿的结局与接受三胎或更高阶多胎妊娠选择性减胎术的女性的结局。
两名评价员独立评估试验质量并提取数据。
未检索到随机对照试验。
现有数据不足以支持对三胎或更高阶多胎妊娠女性实施减胎术政策。虽然随机对照试验将提供关于减胎术风险和益处的最可靠证据，但选择性终止妊娠减少胎儿数量可能不为女性所接受，尤其是那些有过不孕史的女性。该选择的可接受性以及接受随机分组的意愿将取决于夫妇的社会背景和信念，因此，招募此类试验的受试者可能极其困难。
