Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ultrasound Obstet Gynecol. 2023 Jun;61(6):705-709. doi: 10.1002/uog.26170. Epub 2023 May 11.
Data are lacking on the impact on pregnancy outcome of the position of the abnormal fetus in a discordant twin pregnancy undergoing selective termination (ST). Tissue maceration post ST of the presenting twin may lead to early rupture of membranes, amnionitis and preterm labor. The aim of this study was to evaluate pregnancy complications and outcome following ST of the presenting vs non-presenting twin.
This was a multicenter retrospective cohort study of dichorionic diamniotic twin pregnancies that underwent ST due to a discordant fetal anomaly (structural or genetic) between 2007 and 2021. The study population was divided into two groups according to the position of the reduced twin (presenting or non-presenting) and outcomes were studied accordingly. The primary outcome was a composite of early complications following ST, including infection, preterm prelabor rupture of membranes and pregnancy loss.
A total of 190 dichorionic twin pregnancies were included, of which 73 underwent ST of the presenting twin and 117 of the non-presenting twin. The groups did not differ in either baseline demographic characteristics or mean gestational age at the time of the procedure. ST of the presenting twin resulted in a significantly higher rate of early complications compared with the non-presenting twin (19.2% vs 7.7%; P = 0.018). Moreover, the rates of preterm delivery (75.3% vs 37.6%; P < 0.001) and neonatal intensive care unit admission (45.3% vs 17.1%; P < 0.001) were higher, and birth weight was lower (P < 0.001), in those pregnancies in which the presenting twin was reduced.
ST of the presenting twin resulted in a higher rate of adverse pregnancy outcome compared with that of the non-presenting twin. These findings should be acknowledged during patient counseling and, if legislation permits, taken into consideration when planning ST. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
在选择性终止妊娠（ST）中，对于异常胎儿位置的双胎妊娠，目前缺乏对妊娠结局影响的数据。ST 后呈现胎儿的组织浸软可能导致胎膜早破、羊膜炎和早产。本研究旨在评估 ST 后呈现胎儿与非呈现胎儿的妊娠并发症和结局。
这是一项多中心回顾性队列研究，纳入了 2007 年至 2021 年间因胎儿异常（结构或遗传）而接受 ST 的双绒毛膜双羊膜囊双胎妊娠。根据缩小胎儿（呈现或非呈现）的位置，将研究人群分为两组，并进行相应的结局研究。主要结局是 ST 后早期并发症的综合指标，包括感染、早产胎膜早破和妊娠丢失。
共纳入 190 例双绒毛膜双羊膜囊双胎妊娠，其中 73 例接受了呈现胎儿的 ST，117 例接受了非呈现胎儿的 ST。两组在基线人口统计学特征或手术时的平均孕龄方面无差异。与非呈现胎儿的 ST 相比，呈现胎儿的 ST 导致早期并发症的发生率显著更高（19.2% vs 7.7%；P=0.018）。此外，早产率（75.3% vs 37.6%；P<0.001）和新生儿重症监护病房入院率（45.3% vs 17.1%；P<0.001）更高，而出生体重更低（P<0.001），在呈现胎儿被缩小的妊娠中。
与非呈现胎儿的 ST 相比，呈现胎儿的 ST 导致更差的妊娠结局。这些发现应在患者咨询时得到承认，如果立法允许，在计划 ST 时应考虑到这些发现。© 2023 作者。《超声医学杂志》由约翰威立父子出版公司代表国际妇产科超声学会出版。
