Departments of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands.
Academic Medical Center, Amsterdam, The Netherlands.
Am J Obstet Gynecol. 2014 Nov;211(5):536.e1-6. doi: 10.1016/j.ajog.2014.04.023. Epub 2014 Apr 22.
The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins.
This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins.
We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P < .001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins.
In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.
本研究旨在评估三绒毛膜三胎妊娠选择性减胎至双胎的有效性。
这是一项全国性的回顾性队列研究。我们比较了选择性减胎至双胎的三绒毛膜三胎妊娠与继续存在的三绒毛膜三胎妊娠和原发性双胎妊娠的分娩时间和围产儿死亡率。
我们共确定了 86 例减胎后的三绒毛膜三胎妊娠、44 例继续存在的三绒毛膜三胎妊娠和 824 例原发性双胎妊娠。减胎后的三胎妊娠的中位分娩孕周为 36.1 周（四分位距[IQR]，33.3-37.5 周），而继续存在的三胎妊娠为 33.3 周（IQR，28.1-35.2 周），原发性双胎妊娠为 37.1 周（IQR，35.3-38.1 周）（P<.001）。减胎组的存活儿童总数为 155 例（90%），继续存在的三胎妊娠组为 114 例（86%）。减胎后，75 例（87%）妇女的所有胎儿均存活，而继续存在的三胎妊娠组为 36 例（82%）（相对风险[RR]，1.3；95%置信区间[CI]，0.72-2.3），原发性双胎妊娠组为 770 例（93%）（RR，0.91；95% CI，0.82-1）。减胎后有 6 例（7%）妇女无存活儿童，而继续存在的三胎妊娠组有 5 例（11.4%）（RR，0.81；95% CI，0.47-1.4），原发性双胎妊娠组有 32 例（3.9%）（RR，1.7；95% CI，0.8-3.7）。
在三胎妊娠的妇女中，与继续存在的三胎妊娠相比，胎儿减胎可使出生时的胎龄增加 3 周，但对新生儿存活率的影响有限。
