Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, UK; Institute of Reproductive and Developmental Biology, Imperial College London, UK.
Queen Charlotte's and Chelsea Hospital, Imperial Healthcare NHS Trust, UK.
Eur J Obstet Gynecol Reprod Biol. 2021 Sep;264:200-205. doi: 10.1016/j.ejogrb.2021.07.021. Epub 2021 Jul 13.
In trichorionic triplet pregnancies, multifetal pregnancy reduction (MFPR) reduces the risk of preterm birth, neonatal morbidity and mortality without increasing miscarriage. A similar benefit has been suggested in dichorionic triamniotic (DCTA) pregnancy, but multiple methods are currently used. This study investigates if the method of reduction used in DCTA triplet pregnancy influences the evidence of benefit from MFPR.
This is a retrospective cohort study of DCTA pregnancies between 2010 and 2019 who attended a single UK fetal medicine tertiary referral center. Cohorts were defined based on MFPR decision and method. The primary outcome was offspring survival until neonatal discharge. The secondary outcomes included miscarriage, preterm birth, livebirth, rates of small for gestational age (SGA) neonates, ans maternal morbidity. To evaluate the differences in neonatal survival until discharge we used Cox proportional regression to calculate hazard rates (HR) and 95% confidence intervals (CI). Differences in secondary outcomes were compared using univariate analysis.
The study reports the outcomes for 83 DCTA pregnancies. MFPR to DCDA twins was chosen in 19 pregnancies (14 radiofrequency ablation, RFA; 5 intrafetal laser, IFL); in 9 pregnancies selective reduction to a singleton was performed by KCl injection. The rate of pregnancies in with ≥ 1 fetus born alive was not different between groups (p = 0.90). However, the number of expected neonates alive at discharge from hospital was highest in the RFA group (89%, HR 0.28, 95% CI 0.21-0.87, p = 0.02). Rates of premature delivery before 32 weeks (p = 0.02), low birth weight (p < 0.001) and birthweight < 10th percentile (p = 0.01) were all elevated in the expectant management group, compared to women who opted for reduction. There was no difference in miscarriage between groups.
Our study suggests that MFPR by RFA, an established and widely available procedure, is of benefit in promoting neonatal survival until discharge in DCTA triplets.
在三绒毛膜三胎妊娠中，多胎妊娠减少（MFPR）可降低早产、新生儿发病率和死亡率的风险，而不会增加流产。在双绒毛膜三羊膜囊（DCTA）妊娠中也有类似的益处，但目前有多种方法。本研究旨在探讨 DCTA 三胎妊娠中使用的减少方法是否会影响 MFPR 的获益证据。
这是一项回顾性队列研究，纳入了 2010 年至 2019 年在英国一家胎儿医学三级转诊中心就诊的 DCTA 妊娠。根据 MFPR 决策和方法对队列进行定义。主要结局是胎儿存活至新生儿出院。次要结局包括流产、早产、活产、小于胎龄儿（SGA）新生儿的发生率以及产妇发病率。为了评估新生儿存活率的差异，我们使用 Cox 比例风险回归计算风险比（HR）和 95%置信区间（CI）。使用单变量分析比较次要结局的差异。
本研究报告了 83 例 DCTA 妊娠的结局。19 例（14 例射频消融术，RFA；5 例胎儿内激光，IFL）选择 MFPR 减少为双胎绒毛膜性胎盘；9 例选择 KCl 注射减少为单胎妊娠。存活的胎儿数在不同组间无差异（p=0.90）。然而，RFA 组出院时预计存活的新生儿数最高（89%，HR 0.28，95%CI 0.21-0.87，p=0.02）。在期待治疗组中，32 周前早产（p=0.02）、低出生体重（p<0.001）和出生体重<第 10 百分位数（p=0.01）的发生率均高于选择减少的孕妇。两组间流产率无差异。
我们的研究表明，RFA 是一种已确立且广泛应用的方法，在促进 DCTA 三胎妊娠的新生儿存活率方面具有益处。
