Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, TX.
Comprehensive Genetics, PLLC, New York, NY; Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY.
Am J Obstet Gynecol. 2022 Sep;227(3):430-439.e5. doi: 10.1016/j.ajog.2022.03.050. Epub 2022 Mar 26.
This systematic review and meta-analysis aimed to compare the fetal survival rate and perinatal outcomes of triplet pregnancies after selective reduction to twin pregnancies vs singleton pregnancies.
PubMed, Web of Science, Scopus, and Embase were systematically searched from the inception of the databases to January 16, 2022.
Studies comparing the survival and perinatal outcomes between reduction to twin pregnancies and reduction to singleton pregnancies were included. The primary outcomes were fetal survival, defined as a live birth at >24 weeks of gestation. The secondary outcomes were gestational age at birth, preterm birth at <32 and <34 weeks of gestation, early pregnancy loss (<24 weeks of gestation), low birthweight, and rate of neonatal demise (up to 28 days after birth).
The random-effect model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. To provide a range of expected effects if a new study was conducted, 95% prediction intervals were calculated for outcomes presented in >3 studies.
Of note, 10 studies with 2543 triplet pregnancies undergoing fetal reduction, of which 2035 reduced to twin pregnancies and 508 reduced to singleton pregnancies, met the inclusion criteria. Reduction to twin pregnancies had a lower rate of fetal survival (odds ratio, 0.61; 95% confidence interval, 0.40-0.92; P=.02; 95% prediction interval, 0.36-1.03) and comparable rates of early pregnancy loss (odds ratio, 0.89; 95% confidence interval, 0.58-1.38; P=.61; 95% prediction interval, 0.54-1.48) and neonatal demise (odds ratio, 0.57; 95% confidence interval, 0.09-3.50; P=.55) than reduction to singleton pregnancies. Reduction to twin pregnancies had a significantly lower gestation age at birth (weeks) (mean difference, -2.20; 95% confidence interval, -2.80 to -1.61; P<.001; 95% prediction interval, -4.27 to -0.14) than reduction to singleton pregnancies. Furthermore, reduction to twin pregnancies was associated with lower birthweight and greater risk of preterm birth at <32 and <34 weeks of gestation.
Triplet pregnancies reduced to twin pregnancies had a lower fetal survival rate of all remaining fetuses, lower gestational age at birth, higher risk of preterm birth, and lower birthweight than triplet pregnancies reduced to singleton pregnancies; reduction to twin pregnancies vs reduction to singleton pregnancies showed no substantial difference for the rates of early pregnancy loss and neonatal death.
本系统评价和荟萃分析旨在比较选择性减少三胎妊娠至双胎妊娠与单胎妊娠的胎儿存活率和围产结局。
从数据库创建开始到 2022 年 1 月 16 日，系统地检索了 PubMed、Web of Science、Scopus 和 Embase。
纳入比较减少至双胎妊娠和减少至单胎妊娠的胎儿存活率和围产结局的研究。主要结局是胎儿存活率，定义为>24 周的活产。次要结局是出生时的胎龄、<32 周和<34 周的早产、早期妊娠丢失（<24 周）、低出生体重和新生儿死亡（出生后 28 天内）的发生率。
采用随机效应模型汇总均值差或优势比及其相应的 95%置信区间。为了提供如果进行新研究的预期效果范围，如果研究结果>3 项，则计算 95%预测区间。
值得注意的是，有 10 项研究纳入了 2543 例接受胎儿减少的三胎妊娠，其中 2035 例减少至双胎妊娠，508 例减少至单胎妊娠，符合纳入标准。与减少至单胎妊娠相比，减少至双胎妊娠的胎儿存活率较低（比值比，0.61；95%置信区间，0.40-0.92；P=.02；95%预测区间，0.36-1.03），早期妊娠丢失率（比值比，0.89；95%置信区间，0.58-1.38；P=.61；95%预测区间，0.54-1.48）和新生儿死亡（比值比，0.57；95%置信区间，0.09-3.50；P=.55）相似。与减少至单胎妊娠相比，减少至双胎妊娠的出生时胎龄（周）显著较低（平均差异，-2.20；95%置信区间，-2.80 至-1.61；P<.001；95%预测区间，-4.27 至-0.14）。此外，减少至双胎妊娠与较低的出生体重和<32 周和<34 周的早产风险增加相关。
减少至双胎妊娠的三胎妊娠的所有剩余胎儿存活率较低，出生时胎龄较低，早产风险较高，出生体重较低，与减少至单胎妊娠相比；减少至双胎妊娠与减少至单胎妊娠的早期妊娠丢失率和新生儿死亡率无显著差异。
