Shanghai Jiai Genetics and In Vitro Fertilization Center, Obstetrics and Gynecology Hospital affiliated to Fudan University, Shanghai, China.
Department of Obstetrics, Obstetrics and Gynecology Hospital affiliated to Fudan University, Shanghai, China.
J Chin Med Assoc. 2024 Jan 1;87(1):103-108. doi: 10.1097/JCMA.0000000000001017. Epub 2023 Nov 10.
It is recommended to reduce triplet pregnancy containing monochorionic (MC) twins to singleton. Given that some couples with infertility are eager to retain twins, better strategy is needed to avoid obstetrical risks and satisfy their strong wish. This retrospective observational study aimed to investigate the outcomes of triplet pregnancy reduction.
Subjects with triplet pregnancies who underwent selective reduction between 2016 and 2019 at our hospital were enrolled. A total of 66 subjects with dichorionic triplet (DCT) with MC twins and an MC singleton were divided into two groups: group A (N = 38), reduced to dichorionic diamniotic (DCDA) twins; group B (N = 28), reduced to MC diamniotic (MCDA) twins. Obstetrical and perinatal outcomes were compared between groups.
Group A had significantly lower rates of early miscarriage (0% vs 14.3%, p = 0.028), cesarean section (81.6% vs 100%, p = 0.041), and late premature delivery (21.1% vs 45.4%, p = 0.047) than group B. Significantly higher rates of full-term delivery (71% vs 36.4%, p = 0.009) and take-home baby (100% vs 78.6%, p = 0.004), and higher gestational age at delivery (median: 38 [36.9, 39.0] vs 35.8 [34.4, 37.0] weeks, p < 0.001), total neonatal weight (2899.7 ± 647.6 vs 2354.4 ± 651.8 g, p < 0.001), weight of twins (2550 vs 2350 g, p = 0.039), and weight of larger neonate in twins (2790 vs 2500 g, p = 0.045) were observed in group A compared to group B.
DCT reduced to DCDA twins confers better pregnancy outcomes than into MCDA twins. This might benefit for triplet pregnancy subjects who strongly want to retain fraternal twins.
建议减少包含单绒毛膜（MC）双胞胎的三胞胎妊娠至单胎妊娠。鉴于一些不孕不育的夫妇渴望保留双胞胎，因此需要更好的策略来避免产科风险并满足他们强烈的愿望。本回顾性观察研究旨在探讨三胞胎妊娠减少的结局。
本研究纳入了 2016 年至 2019 年在我院接受选择性减少三胞胎妊娠的患者。共有 66 例双绒毛膜（DCT）伴 MC 双胞胎和 1 个 MC 单胎的患者分为两组：A 组（N=38），减少为双绒毛膜双羊膜（DCDA）双胞胎；B 组（N=28），减少为 MC 双羊膜（MCDA）双胞胎。比较两组的产科和围产儿结局。
A 组早期流产率（0% vs. 14.3%，p=0.028）、剖宫产率（81.6% vs. 100%，p=0.041）和晚期早产率（21.1% vs. 45.4%，p=0.047）明显低于 B 组。A 组足月分娩率（71% vs. 36.4%，p=0.009）和活产率（100% vs. 78.6%，p=0.004）明显较高，分娩时的平均孕周（中位数：38[36.9，39.0] vs. 35.8[34.4，37.0]周，p<0.001）、新生儿总体重（2899.7±647.6 vs. 2354.4±651.8g，p<0.001）、双胞胎体重（2550 vs. 2350g，p=0.039）和双胞胎中较大新生儿体重（2790 vs. 2500g，p=0.045）也明显较高。
DCT 减少为 DCDA 双胞胎比减少为 MCDA 双胞胎妊娠结局更好。这可能对强烈希望保留异卵双胞胎的三胞胎妊娠患者有益。
