Bhandari Shilpa, Ganguly Ishita, Agrawal Pallavi, Bhandari Shweta, Singh Aparna, Gupta Nitika
Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
J Hum Reprod Sci. 2016 Jul-Sep;9(3):173-178. doi: 10.4103/0974-1208.192058.
With the advent of assisted reproductive treatment options, the incidence of multiple pregnancies has increased. Although the need for elective single embryo transfer is emphasized time and again, its uniform applicability in practice is yet a distant goal. In view of the fact that triplet and higher order pregnancies are associated with significant fetomaternal complications, the fetal reduction is a commonly used option in such cases. This retrospective study aims to compare the perinatal outcome in patients with triplet gestation who have undergone spontaneous fetal reduction (SFR) as against those in whom multifetal pregnancy reduction (MFPR) was done.
In the present study, eighty patients with triplet gestation at 6 weeks were considered. The patients underwent SFR or MFPR at or before 12-13 weeks and were divided into two groups (34 and 46), respectively.
Our study found no statistical difference in perinatal outcome between the SFR and MFPR groups in terms of average gestational age at delivery, abortion rate, preterm delivery rate, and birth weight. The study shows that the risk of aborting all fetuses after SFR is three times (odds ratio [OR] = 3.600, 95% confidence interval [CI] = 0.2794-46.388) that of MFPR in subsequent 2 weeks. There were more chances of loss of extra fetus in SFR (23.5%) group than MFPR group (8.7%) (OR = 3.889, 95% CI = 1.030-14.680). As neither group offers any significant benefit from preterm delivery, multiple pregnancies continue to be responsible for preterm delivery despite fetal reduction.
There appears to be some advantages of MFPR in perinatal outcome when compared to SFR, especially if the latter happens at advanced gestation. Therefore, although it is advisable to wait for SFR to occur, in patients with triplet gestation at 11-12 weeks, MFPR is a viable option to be considered.
随着辅助生殖治疗方法的出现，多胎妊娠的发生率有所增加。尽管一再强调选择性单胚胎移植的必要性，但其在实际中的普遍应用仍是一个遥远的目标。鉴于三胎及以上妊娠会伴有严重的母胎并发症，减胎术是此类情况下常用的选择。本回顾性研究旨在比较自然减胎（SFR）的三胎妊娠患者与进行多胎妊娠减胎术（MFPR）的患者的围产期结局。
在本研究中，纳入了80例孕6周的三胎妊娠患者。这些患者在12至13周及以前接受了SFR或MFPR，并分别分为两组（34例和46例）。
我们的研究发现，SFR组和MFPR组在分娩时的平均孕周、流产率、早产率和出生体重方面，围产期结局无统计学差异。研究表明，SFR后2周内所有胎儿流产的风险是MFPR的三倍（比值比[OR]=3.600，95%置信区间[CI]=0.2794 - 46.388）。SFR组（23.5%）比MFPR组（8.7%）有更多额外胎儿丢失的机会（OR = 3.889，95% CI = 1.030 - 14.680）。由于两组在早产方面均未显示出明显益处，尽管进行了减胎术，多胎妊娠仍是早产的原因。
与SFR相比，MFPR在围产期结局方面似乎有一些优势，尤其是在孕晚期发生SFR时。因此，尽管等待SFR发生是可取的，但对于11至12周的三胎妊娠患者，MFPR是一个可行的选择。
