Rottenstreich Amihai, Rottenstreich Misgav, Ehrlich Zvi, Ezra Yosef, Mankuta David, Yagel Simcha, Kabiri Doron, Elchalal Uriel, Levin Gabriel
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel.
Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:123-128. doi: 10.1016/j.ejogrb.2020.01.026. Epub 2020 Jan 22.
History of prior preterm birth (PTB) represents one of the strongest risk factors for recurrent PTB. Nevertheless, whether the occurrence of PTB in multifetal gestation is associated with increased risk of PTB in subsequent pregnancies remains unclear. We aimed to determine the recurrence risk of PTB in a subsequent singleton pregnancy after a previous spontaneous preterm triplet delivery.
A retrospective matched case-control study. The study group comprised all women with spontaneous preterm trichorionic triplet delivery who had a subsequent singleton pregnancy during 2006-2017 at two university hospitals. A control group of women with spontaneous preterm dichorionic twin delivery and a subsequent singleton pregnancy, was established by matching, four-to-one, according to maternal age, parity, gestational age at delivery, and delivery year.
Data from 170 women were analyzed, 34 with preterm triplet delivery and 136 matched control women with preterm twin delivery. Gestational age at the subsequent singleton delivery was higher in those with preterm triplet delivery than in those with preterm twin delivery (median 39 vs 38 weeks, P = 0.02). Women with prior triplet PTB had a significantly lower rate of recurrent PTB as compared with women with prior twin PTB (5.9 % vs. 25.0 %; OR [95 % CI]: 0.19 (0.04, 0.82), P = 0.02) with lower proportions of low-birth weight infants (<2500 g) (0 % vs. 11.8 %, P = 0.04).
The risk of recurrent PTB following spontaneous PTB in triplet pregnancy was low compared to preterm twin delivery. These data provide reassurance for those who experienced preterm triplet delivery and suggest the need for further studies to understand the mechanisms contributing to PTB in multifetal pregnancies.
既往早产史是复发性早产最强的风险因素之一。然而，多胎妊娠中的早产发生是否与后续妊娠中早产风险增加相关仍不清楚。我们旨在确定先前自发性早产三胎分娩后，后续单胎妊娠中早产的复发风险。
一项回顾性匹配病例对照研究。研究组包括2006年至2017年期间在两家大学医院有自发性早产三绒毛膜三胎分娩且随后有单胎妊娠的所有女性。通过按产妇年龄、产次、分娩时孕周和分娩年份1:4匹配，建立了一个有自发性早产双绒毛膜双胎分娩且随后有单胎妊娠的对照组。
分析了170名女性的数据，其中34名有早产三胎分娩，136名匹配的对照女性有早产双胎分娩。早产三胎分娩者后续单胎分娩时的孕周高于早产双胎分娩者（中位数39周对38周，P = 0.02）。与有先前双胎早产史的女性相比，有先前三胎早产史的女性复发性早产率显著更低（5.9%对25.0%；OR[95%CI]：0.19(0.04, 0.82)，P = 0.02），低出生体重婴儿（<2500 g）的比例也更低（0%对11.8%，P = 0.04）。
与早产双胎分娩相比，三胎妊娠自发性早产后继发复发性早产的风险较低。这些数据为经历过早产三胎分娩的人提供了安慰，并表明需要进一步研究以了解多胎妊娠中导致早产的机制。
