Department of Maternal-Fetal Medicine, The Royal Hospital for Women, Sydney, New South Wales, Australia.
School of Women's and Children's Health, The University of New South Wales Sydney, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2023 Jun;63(3):365-371. doi: 10.1111/ajo.13636. Epub 2022 Dec 10.
Higher-order multiple (HOM) pregnancies are associated with significant maternal and neonatal morbidity, especially consequent to preterm birth. Multi-fetal pregnancy reduction (MFPR) may be provided, though its benefits in prolonging gestation and improving neonatal outcomes must be weighed against its risks.
The aim was to compare outcomes of HOM pregnancies where expectant management was chosen (EM) with those where MFPR was provided.
The method involved a retrospective study of HOM pregnancies referred to a single quaternary hospital between 2007 and 2016. The primary outcome was gestational age. Secondary outcomes included miscarriage, nursery admission, hospital stay, Apgar scores, early fetal loss, stillbirth, neonatal death and composite fetal loss.
Fifty-seven pregnancies were eligible for inclusion. Median gestation at birth (weeks) was significantly higher for MFPR (35.3 vs 33.1, P < 0.01). Pregnancies after MFPR were less likely to lead to preterm birth (63.2 vs 100.0%, P < 0.001), half as likely to birth before 34 weeks (31.6 vs 60.0%, P = 0.09) but similarly likely to extremely preterm birth (<28 weeks, 8.6 vs 10.5%, P = 0.58). Miscarriage was more likely after MFPR (13.6 vs 0%, P = 0.05). EM neonates were more likely to be admitted to the nursery (P < 0.01) and have longer hospital stay (29.6 vs 20.2 days, P = 0.05); however, they had similar Apgar scores.
Our study demonstrates that MFPR is associated with an increase in gestational age, with a reduction by almost half of births before 34 weeks, but no difference in extremely preterm births; the latter represents the highest risk group. This should be used to guide management counselling for HOM pregnancies.
多胎妊娠（HOM）与母婴发病率显著相关，尤其是与早产有关。多胎妊娠减胎术（MFPR）可能会提供，但需要权衡其延长妊娠和改善新生儿结局的益处与风险。
比较选择期待治疗（EM）和提供 MFPR 的 HOM 妊娠的结局。
这是一项回顾性研究，纳入了 2007 年至 2016 年期间在一家四级医院就诊的 HOM 妊娠。主要结局是胎龄。次要结局包括流产、新生儿病房入院、住院时间、阿普加评分、早期胎儿丢失、死胎、新生儿死亡和复合胎儿丢失。
57 例妊娠符合纳入标准。MFPR 组的中位分娩孕周（周）显著较高（35.3 与 33.1，P<0.01）。MFPR 组的早产率较低（63.2%与 100.0%，P<0.001），分娩前 34 周的可能性减半（31.6%与 60.0%，P=0.09），但极早产的可能性相似（<28 周，8.6%与 10.5%，P=0.58）。MFPR 后流产的可能性更高（13.6%与 0%，P=0.05）。EM 新生儿更有可能被送入新生儿病房（P<0.01），住院时间更长（29.6 与 20.2 天，P=0.05）；然而，他们的阿普加评分相似。
我们的研究表明，MFPR 与胎龄增加相关，分娩前 34 周的比例降低近一半，但极早产的比例无差异；后者代表风险最高的群体。这应该用于指导 HOM 妊娠的管理咨询。
