Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
Am J Obstet Gynecol. 2015 Nov;213(5):637-43. doi: 10.1016/j.ajog.2015.04.035. Epub 2015 Apr 30.
The aim of this study was to analyze perinatal outcomes after selective reduction in monochorionic pregnancies with the use of either radiofrequency ablation (RFA) or bipolar cord occlusion (BCO). This was a systematic review and metaanalysis that included all studies with ≥5 cases that described perinatal outcomes after BCO or RFA that were identified in PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search Premier, Science Direct, and MEDLINE that were published between 1965 and July 2014. For count data, incidence risk ratios (IRR; 95% confidence interval [CI]) were calculated with BCO as the reference standard. The analysis included 481 cases of BCO and 320 cases of RFA from 17 studies. The mean median gestations at procedure were 21.1 ± 1.2 weeks (BCO) and 18.8 ± 2.5 weeks (RFA; P = .03). The rate of cotwin death was higher in the RFA group (14.7%) vs the BCO group (10.6%; IRR, 1.38; 95% CI, 0.93-2.05; P = .11). The live birth rate was 81.3% for the RFA group and 86.7% in the BCO group (IRR, 0.93; 95% CI, 0.80-1.09; P = .41). BCO had higher neonatal death rates (8.1%) vs RFA (4.5%; IRR, 0.56; 95% CI, 0.30-1.04; P = .07). Overall survival was 76.8% for RFA and 79.1% for BCO (IRR, 0.97; 95% CI, 0.82-1.14; P = .72); however, none of these differences were statistically significant. Preterm premature rupture of membranes occurred in 17.7% of RFA cases and 28.2% of the BCO cases (IRR, 0.63; 95% CI, 0.43-0.91; P = .01). The mean median gestational age at delivery was 34.7 ± 1.7 weeks in the RFA group and 35.1 ± 1.6 weeks in the BCO group. Our data do not demonstrate clearly the superiority of 1 procedure over the other. The clinical situation and preference of the operator are important considerations. Rates of preterm delivery and preterm premature rupture of membranes remain substantial for both procedures.
本研究旨在分析应用射频消融（RFA）或双极脐带结扎（BCO）选择性减少联体双胎妊娠的围产结局。这是一项系统评价和荟萃分析，纳入了所有描述 BCO 或 RFA 后围产结局的≥5 例研究，这些研究均来自 PubMed、Embase、Web of Science、COCHRANE、CINAHL、Academic Search Premier、Science Direct 和 MEDLINE，发表时间为 1965 年至 2014 年 7 月。对于计数资料，以 BCO 为参照标准，计算发病率风险比（IRR；95%置信区间[CI]）。该分析纳入了 17 项研究中的 481 例 BCO 和 320 例 RFA。手术时的中位孕龄分别为 21.1±1.2 周（BCO）和 18.8±2.5 周（RFA；P=0.03）。RFA 组胎儿死亡的发生率（14.7%）高于 BCO 组（10.6%；IRR，1.38；95%CI，0.93-2.05；P=0.11）。RFA 组的活产率为 81.3%，BCO 组为 86.7%（IRR，0.93；95%CI，0.80-1.09；P=0.41）。BCO 的新生儿死亡率（8.1%）高于 RFA（4.5%；IRR，0.56；95%CI，0.30-1.04；P=0.07）。RFA 的总生存率为 76.8%，BCO 为 79.1%（IRR，0.97；95%CI，0.82-1.14；P=0.72）；然而，这些差异均无统计学意义。RFA 组的早产胎膜早破发生率为 17.7%，BCO 组为 28.2%（IRR，0.63；95%CI，0.43-0.91；P=0.01）。RFA 组的中位分娩孕龄为 34.7±1.7 周，BCO 组为 35.1±1.6 周。我们的数据并未明确显示一种方法优于另一种。临床情况和术者的偏好是重要的考虑因素。对于这两种方法，早产和早产胎膜早破的发生率仍然较高。
