Institute of Reproductive and Stem Cell Engineering, Central South University, Changsha City, 410078, Hunan, China.
Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, 410078, Hunan, China.
BMC Pregnancy Childbirth. 2020 Mar 17;20(1):165. doi: 10.1186/s12884-020-2815-4.
Trichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. However, data on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are lacking. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11-13 gestational weeks.
Two hundred ninety-eight patients with DCTA triplets conceived via IVF-ET between 2012 and 2016 were retrospectively analysed. DCTA triplets with three live foetuses were reduced to a MC singleton (group A) or MCDA twins (group B) or underwent expectant management (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11-13 gestational weeks. Pregnancy outcomes in the 3 groups were compared.
Eighty-four DCTA pregnancies were reduced to MC singleton pregnancies, 149 were reduced to MCDA pregnancies, and 65 were managed expectantly. There were no significant differences among groups A, B, and C in miscarriage rate (8.3 vs. 7.4 vs. 10.8%, respectively) and live birth rate (90.5 vs. 85.2 vs. 83.1%, respectively) (P > 0.05). Group A had significantly lower rates of preterm birth (8.3 vs. 84.6%; odds ratio (OR) 0.017, 95% confidence interval (CI) 0.006-0.046) and low birth weight (LBW; 9.2 vs. 93.2%; OR 0.007, 95% CI 0.003-0.020) than group C (P < 0.001). Group B had significantly lower preterm birth (47.0 vs. 84.6%; OR 0.161, 95% CI 0.076-0.340) and LBW rates (58.7 vs. 93.2%; OR 0.103, 95% CI 0.053-0.200) than group C (P < 0.001). Group A had significantly lower preterm birth (8.3 vs. 47.0%; OR 0.103, 95% CI 0.044-0.237; P < 0.001), LBW (9.2 vs. 58.7%; OR 0.071, 95% CI 0.032-0.162; P < 0.001) and perinatal death rates (1.3 vs. 9.1%; OR 0.132, 95% CI 0.018-0.991; P = 0.021) than group B.
The MFPR of DCTA triplets to singleton or MCDA pregnancies was associated with better pregnancy outcomes compared to expectant management. DCTA triplets reduced to singleton pregnancies had better perinatal outcomes than DCTA triplets reduced to MCDA pregnancies.
三绒毛膜三胎妊娠减胎至双胎妊娠与早产风险降低相关，但与流产风险降低无关。然而，关于双绒毛膜三羊膜囊（DCTA）三胎妊娠结局的数据尚缺乏。本研究旨在比较经体外受精-胚胎移植（IVF-ET）受孕的 DCTA 三胎妊娠经期待治疗或减胎为单绒毛膜（MC）单胎或单绒毛膜双羊膜囊（MCDA）双胎妊娠在 11-13 孕周时的妊娠结局。
回顾性分析 2012 年至 2016 年期间经 IVF-ET 受孕的 298 例 DCTA 三胎妊娠患者。三胎妊娠中有 3 个活胎的 DCTA 妊娠被减胎为 MC 单胎（A 组）或 MCDA 双胎（B 组），或进行期待治疗（C 组）。每个多胎妊娠减胎术（MFPR）均在 11-13 孕周进行。比较 3 组的妊娠结局。
84 例 DCTA 妊娠被减胎为 MC 单胎妊娠，149 例被减胎为 MCDA 妊娠，65 例进行期待治疗。A、B 和 C 组之间的流产率（分别为 8.3%、7.4%和 10.8%）和活产率（分别为 90.5%、85.2%和 83.1%）无显著差异（P>0.05）。A 组早产率（8.3%比 84.6%；比值比（OR）0.017，95%置信区间（CI）0.006-0.046）和低出生体重（LBW；9.2%比 93.2%；OR 0.007，95%CI 0.003-0.020）明显低于 C 组（P<0.001）。B 组早产率（47.0%比 84.6%；OR 0.161，95%CI 0.076-0.340）和 LBW 率（58.7%比 93.2%；OR 0.103，95%CI 0.053-0.200）明显低于 C 组（P<0.001）。A 组早产率（8.3%比 47.0%；OR 0.103，95%CI 0.044-0.237；P<0.001）、LBW 率（9.2%比 58.7%；OR 0.071，95%CI 0.032-0.162；P<0.001）和围产儿死亡率（1.3%比 9.1%；OR 0.132，95%CI 0.018-0.991；P=0.021）明显低于 B 组。
与期待治疗相比，DCTA 三胎妊娠的 MFPR 为单胎或 MCDA 妊娠与更好的妊娠结局相关。与减胎为 MCDA 妊娠相比，减胎为单胎妊娠的 DCTA 三胎妊娠的围产儿结局更好。
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