Donepudi Roopali, Hessami Kamran, Nassr Ahmed A, Espinoza Jimmy, Sanz Cortes Magdalena, Sun Luming, Shirazi Mahboobeh, Yinon Yoav, Belfort Michael A, Shamshirsaz Alireza A
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX.
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt.
Am J Obstet Gynecol. 2022 May;226(5):646-655.e3. doi: 10.1016/j.ajog.2021.10.018. Epub 2021 Oct 19.
This systematic review and meta-analysis aimed to compare the perinatal outcomes of complicated monochorionic pregnancies after selective reduction by radiofrequency ablation, bipolar cord coagulation, and interstitial laser.
We searched PubMed, Scopus, and Web of Science, from the inception of the database up to April 26, 2021.
Studies comparing at least 2 selective reduction techniques among complicated monochorionic pregnancies and presenting data on perinatal outcomes, including gestational age at procedure, gestational age at delivery, procedure to delivery interval, preterm premature rupture of membranes, preterm birth, survival rate, and birthweight, were eligible.
The random-effects model was used to pool the mean differences or odds ratios and corresponding 95% confidence intervals. Heterogeneity was assessed using the I value.
A total of 10 studies with 734 cases of fetal reduction met the inclusion criteria, of which 9 studies with 674 fetuses were eligible for quantitative synthesis. In 8 studies that compared radiofrequency ablation with bipolar cord coagulation, radiofrequency ablation was associated with increased procedure to delivery interval (days) (mean difference, 13.42; 95% confidence interval, 1.90-24.94; P=.02; I=0.0%), decreased preterm birth (odds ratio, 0.50; 95% confidence interval, 0.29-0.85; P=.01; I=3.0%), and decreased preterm premature rupture of membranes (odds ratio, 0.45; 95% confidence interval, 0.27-0.73; P=.001; I=0.0%). Radiofrequency ablation and bipolar cord coagulation had comparable survival rates (odds ratio, 0.85; 95% confidence interval, 0.54-1.35; P=.49; I=0.0%). In 3 studies that compared radiofrequency ablation with interstitial laser, there was no significant difference in gestational age at delivery (P=.07) or survival (P=.15). In 3 studies that compared bipolar cord coagulation with interstitial laser, bipolar cord coagulation was associated with a higher survival rate (odds ratio, 3.21; 95% confidence interval, 1.13-9.10; P=.03; I=0.0%), but the gestational age at delivery was comparable between groups (P=.16).
This study demonstrated that radiofrequency ablation has a greater procedure to delivery interval and decreased preterm premature rupture of membranes and preterm birth than bipolar cord coagulation. Although there was no difference in gestational age at delivery for either bipolar cord coagulation, radiofrequency ablation, or interstitial laser, survival was higher with bipolar cord coagulation than with interstitial laser.
本系统评价和荟萃分析旨在比较经射频消融、双极脐带凝固术和间质激光消融进行选择性减胎术后复杂单绒毛膜妊娠的围产期结局。
我们检索了PubMed、Scopus和Web of Science数据库，检索时间从数据库建立至2021年4月26日。
比较复杂单绒毛膜妊娠中至少两种选择性减胎技术，并提供围产期结局数据的研究符合要求，这些数据包括手术时的孕周、分娩时的孕周、手术至分娩间隔、胎膜早破、早产、存活率和出生体重。
采用随机效应模型合并平均差或比值比及相应的95%置信区间。使用I²值评估异质性。
共有10项涉及734例减胎病例的研究符合纳入标准，其中9项涉及674例胎儿的研究符合定量综合分析的要求。在8项比较射频消融与双极脐带凝固术的研究中，射频消融与手术至分娩间隔天数增加相关（平均差，13.42；95%置信区间，1.90 - 24.94；P = 0.02；I² = 0.0%），早产发生率降低（比值比，0.50；95%置信区间，0.29 - 0.85；P = 0.01；I² = 3.0%），胎膜早破发生率降低（比值比，0.45；95%置信区间，0.27 - 0.73；P = 0.001；I² = 0.0%）。射频消融与双极脐带凝固术的存活率相当（比值比，0.85；95%置信区间，0.54 - 1.35；P = 0.49；I² = 0.0%）。在3项比较射频消融与间质激光消融的研究中，分娩时的孕周（P = 0.07）或存活率（P = 0.15）无显著差异。在3项比较双极脐带凝固术与间质激光消融的研究中，双极脐带凝固术的存活率更高（比值比，3.21；95%置信区间，1.13 - 9.10；P = 0.03；I² = 0.0%），但两组间分娩时的孕周相当（P = 0.16）。
本研究表明，与双极脐带凝固术相比，射频消融的手术至分娩间隔更长，胎膜早破和早产发生率更低。虽然双极脐带凝固术、射频消融或间质激光消融在分娩时的孕周上没有差异，但双极脐带凝固术的存活率高于间质激光消融。
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