Department of Human Structure and Repair, Ghent University, Ghent, Belgium (Ms Meireson and Dr Roelens); Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Ms Meireson and Drs De Rycke, Dehaene, Derom, and Roelens).
Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Ms Meireson and Drs De Rycke, Dehaene, Derom, and Roelens).
Am J Obstet Gynecol MFM. 2024 Jan;6(1):101230. doi: 10.1016/j.ajogmf.2023.101230. Epub 2023 Nov 19.
The introduction of assisted reproductive technology and the trend of increasing maternal age at conception have contributed to a significant rise in the incidence of multiple pregnancies. Multiple pregnancies bear several inherent risks for both mother and child. These risks increase with plurality and type of chorionicity. Multifetal pregnancy reduction is the selective abortion of ≥1 fetuses to improve the outcome of the remaining fetus(es) by decreasing the risk of premature birth and other complications.
This study aimed to compare birth outcomes of trichorionic triplets reduced to twins with those of trichorionic triplets and primary dichorionic twins. The added value of this study is the comparison with an additional control group, namely primary dichorionic twins.
This was a retrospective cohort study. Data from January 1990 to November 2016 were collected from the East Flanders Prospective Twin Survey, one of the largest European multiple birth registries. A total of 85 trichorionic triplet pregnancies (170 neonates) undergoing multifetal pregnancy reduction to twins were compared with 5093 primary dichorionic twin pregnancies (10,186 neonates) and 104 expectantly managed trichorionic triplet pregnancies (309 neonates). The assessed outcomes were gestational age at delivery, birthweight, and small for gestational age.
Pregnancy reduction from triplets to twins was associated with higher birthweight (+365.44 g; 95% confidence interval, 222.75-508.14 g; P<.0001) and higher gestational age (1.7 weeks; 95% confidence interval, 0.93-2.46; P<.0001) compared with ongoing trichorionic triplets after adjustment for sex, parity, method of conception, birth year, and maternal age. A trend toward lower risk of small for gestational age was observed. Reduced triplets had, on average, lower birthweight (-263.12 g; 95% confidence interval, -371.80 to -154.44 g; P<.0001) and lower gestational age (-1.13 weeks; 95% confidence interval, -1.70 to -0.56; P=.0001) compared with primary twins. No statistically significant difference was observed between primary twins and reduced triplets that reached 32 weeks of gestation.
Multifetal pregnancy reduction from trichorionic triplets to twins significantly improved birth outcomes. This suggests that multifetal pregnancy reduction of trichorionic triplets to twins is medically justifiable. However, the birth outcomes of primary twins before 32 weeks of gestation are still better than those of reduced triplets. The process of multifetal pregnancy reduction includes at least 1 fetal death by definition, and thus prevention of higher-order pregnancies is preferable.
辅助生殖技术的引入和受孕母亲年龄的增长趋势导致多胎妊娠的发生率显著上升。多胎妊娠对母婴都存在一些固有风险。这些风险随着多胎妊娠的数量和绒毛膜性的不同而增加。多胎妊娠减胎术是选择性流产≥1 个胎儿，以降低早产和其他并发症的风险，从而改善剩余胎儿的结局。
本研究旨在比较减胎为双胎的三绒毛膜性三胎妊娠与三绒毛膜性三胎妊娠和原发性双绒毛膜性双胎妊娠的分娩结局。本研究的附加价值在于与另一个对照组，即原发性双绒毛膜性双胎妊娠进行比较。
这是一项回顾性队列研究。数据来自 1990 年 1 月至 2016 年 11 月的东佛兰德前瞻性双胞胎调查，这是欧洲最大的多个出生登记处之一。总共对 85 例接受多胎妊娠减胎为双胎的三绒毛膜性三胎妊娠（170 例新生儿）进行了研究，并与 5093 例原发性双绒毛膜性双胎妊娠（10186 例新生儿）和 104 例期待管理的三绒毛膜性三胎妊娠（309 例新生儿）进行了比较。评估的结局包括分娩时的胎龄、出生体重和小于胎龄儿。
与继续妊娠的三绒毛膜性三胎妊娠相比，三胎妊娠减胎为双胎妊娠时出生体重更高（增加 365.44 克；95%置信区间，222.75-508.14 克；P<.0001），胎龄更长（1.7 周；95%置信区间，0.93-2.46；P<.0001），但需要注意的是，这些差异在调整了性别、产次、受孕方式、出生年份和母亲年龄后仍然存在。观察到小于胎龄儿的风险呈下降趋势。与原发性双胎妊娠相比，减胎的三绒毛膜性三胎妊娠的平均出生体重（-263.12 克；95%置信区间，-371.80 至-154.44 克；P<.0001）和胎龄（-1.13 周；95%置信区间，-1.70 至-0.56；P=.0001）均较低。达到 32 周妊娠的原发性双胎妊娠与减胎的三绒毛膜性三胎妊娠之间未观察到统计学上的显著差异。
三绒毛膜性三胎妊娠减胎为双胎妊娠显著改善了分娩结局。这表明三绒毛膜性三胎妊娠减胎术在医学上是合理的。然而，在 32 周之前，原发性双胎妊娠的分娩结局仍优于减胎的三绒毛膜性三胎妊娠。多胎妊娠减胎术的过程至少包括 1 例胎儿死亡，因此最好预防多胎妊娠。
