Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
Prenat Diagn. 2022 Jul;42(8):970-977. doi: 10.1002/pd.6161. Epub 2022 May 4.
To compare the outcomes of monochorionic triamniotic (MCTA) triplets managed expectantly with those reduced to twins.
This was a retrospective cohort study comparing expectant management (EM) with fetal reduction (FR) to twins in 43 consecutive MCTA triplets with 3 live fetuses at 11-14 weeks between 2012 and 2021.
Nineteen patients managed expectantly and 24 triplets reduced to twins were included. The rate of pregnancy with at least one survivor was 84.2% in the EM group and 66.7% in the FR group (P = 0.190). Compared to the EM cases, triplets reduced to twins had a higher median gestational age at delivery (36.0 vs. 33.3 weeks; P < 0.001), a higher mean birth weight (2244.3 ± 488.6 g vs. 1751.1 ± 383.2 g; P < 0.001) and a lower risk of preterm birth before 34 weeks (11.8% vs. 64.7%; P = 0.001). There were no significant differences in the risk of miscarriage, pregnancy complications and composite adverse neonatal outcomes.
In MCTA triplets, FR to twins could reduce the risk of preterm birth, whereas EM seems to be a reasonable choice when the priority is at least one survivor. However, due to the small sample size of this study, these findings must be interpreted with great caution.
比较期待治疗（expectant management，EM）与减胎至双胎对单绒毛膜三羊膜囊（monochorionic triamniotic，MCTA）三胎妊娠结局的影响。
这是一项回顾性队列研究，纳入了 2012 年至 2021 年间 43 例连续 MCTA 三胎妊娠中 11-14 周时 3 个活胎的病例，将期待治疗（EM）与减胎至双胎（fetal reduction，FR）进行比较。
19 例患者接受期待治疗，24 例三胎妊娠减胎至双胎。在 EM 组中，至少有一个存活儿的妊娠率为 84.2%，在 FR 组中为 66.7%（P=0.190）。与 EM 病例相比，减胎至双胎的中位分娩孕周更高（36.0 周比 33.3 周；P<0.001），平均出生体重更大（2244.3±488.6 g 比 1751.1±383.2 g；P<0.001），且 34 周前早产的风险更低（11.8%比 64.7%；P=0.001）。两组在流产风险、妊娠并发症和复合不良新生儿结局风险方面无显著差异。
在 MCTA 三胎妊娠中，FR 至双胎可以降低早产风险，而当首要目标是至少有一个存活儿时，EM 似乎是合理的选择。然而，由于本研究的样本量较小，这些发现必须谨慎解释。
