Fetal Therapy, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
Prenat Diagn. 2023 Jul;43(8):1028-1035. doi: 10.1002/pd.6385. Epub 2023 May 18.
To assess the perinatal outcome after fetal reduction in complicated monochorionic (MC) twin pregnancies by comparing different techniques.
A retrospective cohort study at a national referral center comparing data between four techniques: interstitial laser coagulation, radiofrequency ablation (RFA), fetoscopic laser coagulation (FLC) and bipolar cord coagulation (BCC). The primary outcome was the mortality of the co-twins. Secondary outcomes were preterm pre-labor rupture of membranes (PPROM), gestational age at delivery and neonatal morbidity.
259 MC twin pregnancies underwent selective fetal reduction: 29 IL, 64 RFA, 85 FLC and 81 BCC. The perinatal mortality rate was 29% and fetal demise of the co-twins occurred in 19%. The lowest mortality rate was seen after BCC (17%, p = 0.012). PPROM occurred in 18% patients without significant differences between techniques. The mean gestational age at delivery in liveborn children was 35 weeks and did not differ between techniques. Severe cerebral injury and neonatal morbidity were reported in 4% and 14%, respectively, without significant differences between techniques.
Selective fetal reductions in MC twins are precarious procedures with an increased risk of perinatal mortality of the co-twins. Our results show the lowest mortality rates after BCC. However, high PPROM rates were seen irrespective of the technique.
通过比较不同技术，评估复杂性单绒毛膜（MC）双胎妊娠胎儿减少术的围产结局。
这是在国家转诊中心进行的回顾性队列研究，比较了四种技术的数据：间质激光凝固术、射频消融术（RFA）、胎儿镜激光凝固术（FLC）和双极脐带凝固术（BCC）。主要结局是双胎之一的死亡率。次要结局是早产胎膜早破（PPROM）、分娩时的孕龄和新生儿发病率。
259 例 MC 双胎妊娠行选择性胎儿减少术：29 例行 IL，64 例行 RFA，85 例行 FLC，81 例行 BCC。围产儿死亡率为 29%，双胎之一死亡 19%。BCC 组的死亡率最低（17%，p=0.012）。PPROM 发生率为 18%，各技术之间无显著差异。活产儿的平均分娩孕龄为 35 周，各技术之间无显著差异。严重脑损伤和新生儿发病率分别为 4%和 14%，各技术之间无显著差异。
MC 双胎妊娠的选择性胎儿减少术是一种危险的手术，双胎之一的围产儿死亡率增加。我们的结果显示 BCC 后死亡率最低。然而，无论采用哪种技术，PPROM 的发生率都很高。
