Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare Trust, Du Cane Road, London W12 0HS, UK.
Semin Fetal Neonatal Med. 2010 Dec;15(6):327-35. doi: 10.1016/j.siny.2010.08.002. Epub 2010 Sep 22.
The substantial increase in high order multiple pregnancies in the last two decades as a result of assisted reproductive techniques has necessitated the development of multifetal pregnancy reduction as a management tool to decrease fetal number and improve perinatal survival. The evidence in favour of reduction in pregnancies with more than four fetuses to twins is undisputed. Despite the recent improvements in expectant management of triplets with reasonable perinatal outcomes, the evidence suggests that reduction to twins significantly reduces the risk of preterm delivery without an increase in miscarriage rates. Recent advances in vascular-occlusive techniques have allowed the possibility of selective termination in monochorionic pregnancies in the presence of discordant anomalies or indeed multifetal reduction in non-trichorionic triplets, with radiofrequency ablation and cord occlusion appearing to be the most successful. However, the techniques vary in complexity and complication rates, which increase with gestation. Hence the need to refer these pregnancies early to specialist centres.
由于辅助生殖技术的发展，过去二十年中多胎妊娠的数量显著增加，这使得多胎妊娠减胎术成为一种管理工具，以减少胎儿数量并提高围产儿存活率。减少四胎以上妊娠以获得双胞胎的证据是无可争议的。尽管最近在期待治疗三胞胎方面取得了进展，并且围产儿结局合理，但有证据表明，减胎至双胞胎可显著降低早产风险，而不会增加流产率。血管阻塞技术的最新进展使得在存在不一致畸形的情况下或在非三绒毛膜三胞胎中进行选择性终止的可能性成为可能，射频消融和脐带闭塞似乎是最成功的。然而，这些技术在复杂性和并发症发生率方面存在差异，并且随着妊娠的进行而增加。因此，需要将这些妊娠及早转介到专业中心。
