期待治疗的三绒毛膜三胎妊娠的近期和远期结局。
Short-term and long-term outcomes of trichorionic triplet pregnancies with expectant management.
机构信息
Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
Acta Obstet Gynecol Scand. 2022 Jan;101(1):111-118. doi: 10.1111/aogs.14281. Epub 2021 Nov 7.
INTRODUCTION
Reproductive endocrinologists recommend selective multifetal pregnancy reduction (MFPR) to save at least one or two babies, because triplet pregnancy is known to increase the risk of miscarriage and preterm delivery. However, recently improved obstetric and neonatal care may affect pregnancy outcomes differently in triplet pregnancies, which could alter practice. We compared the maternal, perinatal, and long-term outcomes of triplet pregnancies managed expectantly with those of pregnancies reduced to twins.
MATERIAL AND METHODS
In this retrospective cohort study, we reviewed the clinical records of 552 trichorionic triplet pregnancies for obstetric, perinatal, and neurodevelopmental outcomes, which consisted of the expectant management (EM) group (n = 225) and MFPR group (n = 327), in Seoul National University Hospital and CHA Bundang Medical Center from January 2006 to December 2018. Neuromotor development was evaluated using the Korean-Ages and Stages Questionnaire, Bayley-III tests, and/or Gross Motor Function Measure. The two groups were compared for the following outcomes: (1) nonviable pregnancy loss before 23 weeks, (2) preterm birth before 32 weeks of gestation, (3) fetal and neonatal survival and (4) long-term neurodevelopmental outcomes.
RESULTS
There were no differences in maternal age, body mass index, nulliparity or previous preterm birth between the two groups. The risk of nonviable pregnancy loss was lower in the EM group than that in the MFPR group (2 [0.9%] vs 21 [6.4%], p = 0.001). The risk of preterm delivery before 34 weeks of gestation was lower in the MFPR group (adjusted odds ratios [aOR] = 0.47, 95% confidence interval [CI] 0.30-0.73, p = 0.001). The survival rate of neonates until discharge (644 [95.4%] vs 572 [87.5], p < 0.001) and the rate of pregnancies with at least one survivor (220 [97.8%] vs 301 [92.0], p = 0.002) were higher in the EM group than those in the MFPR group. In the MFPR group, the risk of developmental delay (aOR = 2.89, 95% CI 1.38-6.02, p = 0.005) was higher.
CONCLUSIONS
In trichorionic triplet pregnancies, the possibility of EM to improve survival and reduce the risk of developmental delay has been shown.
简介
生殖内分泌学家建议选择性多胎妊娠减少（MFPR）以挽救至少一个或两个婴儿，因为众所周知，三胞胎妊娠会增加流产和早产的风险。然而，最近产科和新生儿护理的改善可能会对三胞胎妊娠的妊娠结局产生不同的影响，从而改变实践。我们比较了期待治疗（EM）组（n=225）和 MFPR 组（n=327）中三绒毛膜三胞胎妊娠的母婴、围产儿和长期结局，MFPR 组的妊娠减少到双胞胎。
材料和方法
在这项回顾性队列研究中，我们回顾了 2006 年 1 月至 2018 年 12 月在首尔国立大学医院和 CHA Bundang 医疗中心的 552 例三绒毛膜三胞胎妊娠的产科、围产儿和神经发育结局的临床记录，这些妊娠分为期待治疗（EM）组（n=225）和 MFPR 组（n=327）。神经运动发育使用韩国年龄和阶段问卷、贝利-III 测试和/或总体运动功能测量进行评估。比较两组以下结局：（1）23 周前无生命妊娠丢失，（2）32 周前早产，（3）胎儿和新生儿存活和（4）长期神经发育结局。
结果
两组间母亲年龄、体重指数、初产妇或既往早产无差异。EM 组无生命妊娠丢失的风险低于 MFPR 组（2[0.9%] vs 21[6.4%]，p=0.001）。MFPR 组 34 周前早产的风险较低（调整后的优势比[aOR]=0.47，95%置信区间[CI]0.30-0.73，p=0.001）。新生儿出院时的存活率（644[95.4%] vs 572[87.5%]，p<0.001）和至少有一名幸存者的妊娠率（220[97.8%] vs 301[92.0%]，p=0.002）均高于 MFPR 组。MFPR 组发育迟缓的风险较高（aOR=2.89，95%CI 1.38-6.02，p=0.005）。
结论
在三绒毛膜三胞胎妊娠中，EM 提高存活率和降低发育迟缓风险的可能性已经得到证实。
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