Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Dr Shterev Hospital, Sofia, Bulgaria.
Ultrasound Obstet Gynecol. 2017 Nov;50(5):632-634. doi: 10.1002/uog.18834. Epub 2017 Oct 5.
To report the outcome of dichorionic (DC) triplet pregnancies reduced to DC twins by laser ablation of the pelvic vessels of one of the monochorionic (MC) twins.
Intrafetal laser embryo reduction (ER) from DC triplets to DC twins was carried out in 61 pregnancies at 11 + 0 to 14 + 3 weeks' gestation. Pregnancy outcome was examined.
Intrafetal laser was successfully carried out in all cases, but ultrasound examination within 2 weeks of the procedure demonstrated that the MC cotwin had died in 28 (45.9%) cases and was alive in the other 33 (54.1%). In the DC group, there was one miscarriage at 23 weeks, one neonatal death after delivery at 26 weeks and in the other 31 cases there were two live births at a median gestational age of 35.3 (range, 30.4-38.4) weeks. In the 28 cases in which both MC fetuses died, there was one miscarriage at 16 weeks and in the other 27 cases the separate triplet was liveborn at a median gestation of 38.2 (range, 32.2-42.1) weeks. The overall rate of miscarriage was 3.3% (2/61) and that of preterm birth (PTB) at < 33 weeks was 6.8% (4/59).
In the management of DC triplet pregnancies, ER to DC twins by intrafetal laser ablation is associated with lower rates of miscarriage or early PTB, compared with expectant management or ER by fetal intracardiac injection of potassium chloride. However, about half of the pregnancies result in the birth of one rather than two babies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
报道通过激光消融其中一个单绒毛膜（MC）双胞胎的盆腔血管，将双绒毛膜（DC）三胎妊娠减少为双绒毛膜（DC）双胞胎的结局。
在 11+0 至 14+3 周的妊娠期间，对 61 例 DC 三胎妊娠进行了宫内激光胚胎减少（ER），使妊娠减少为 DC 双胞胎。检查妊娠结局。
所有病例均成功进行了宫内激光，但在操作后 2 周内的超声检查显示，28 例（45.9%）MC 联体胎儿死亡，33 例（54.1%）存活。在 DC 组中，有 1 例在 23 周流产，1 例在 26 周分娩后新生儿死亡，在其他 31 例中，有 2 例在中位孕龄 35.3（范围 30.4-38.4）周时活产。在两个 MC 胎儿均死亡的 28 例中，有 1 例在 16 周流产，在其他 27 例中，单独的三胎在中位孕龄 38.2（范围 32.2-42.1）周时活产。总的流产率为 3.3%（2/61），<33 周早产率为 6.8%（4/59）。
与期待治疗或胎儿心内注射氯化钾的 ER 相比，在 DC 三胎妊娠的管理中，通过宫内激光消融将 ER 减少为 DC 双胞胎与较低的流产率或早产率相关。然而，大约一半的妊娠导致只生下一个而不是两个婴儿。版权所有©2017ISUOG。由 John Wiley & Sons Ltd 出版。
