Zou Gang, Ji Qingfang, Chen Jianping, Zhang Luye, Sun Qianqian, Shi Yaqi, Yang Yingjun, Zhou Fenhe, Wei Xing, Sun Luming
Shanghai Key Laboratory of Maternal Fetal Medicine, Department of Fetal Medicine and Prenatal Diagnosis Center, School of Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China.
Front Med (Lausanne). 2024 Jan 16;10:1327191. doi: 10.3389/fmed.2023.1327191. eCollection 2023.
The study aimed to evaluate the pregnancy outcomes of dichorionic diamniotic twin pregnancies that were reduced to singletons at different gestational ages.
This was a retrospective cohort study of twin pregnancies that underwent fetal reduction to singletons in a single tertiary referral center between 2011 and 2020. A total of 433 cases were included. The cohort was divided into five groups according to gestational age at surgery: Group A: <16 weeks (125 cases); Group B: 16-19 weeks (80 cases); Group C: 20-23 weeks (74 cases); Group D: 24-26 weeks (48 cases); and Group E: ≥27 weeks (106 cases). Outcome data were obtained by reviewing the electronic medical records or interviews.
Selective reduction was technically successful. The clinical characteristics of the population were not different. The overall live birth rate and the survival rate were 96.5 and 95.4%, respectively. Although the rate of spontaneous miscarriage was comparable, gestational age at delivery significantly differed among groups ( < 0.001). Additionally, there was a trend that gestational age at delivery decreased with the increasing gestational age at surgery in Groups A, B, C, and D, whereas gestational age at delivery in Group E was later than that in Group D. In Groups A, B, C, and D, the rates of preterm birth at <32 weeks and <34 weeks increased with the increasing gestational age at surgery, while the rates in Group E were significantly lower than that in Group D. Regression analysis showed that timing of reduction may be an independent factor after adjusting for maternal age, parity, pre-pregnancy BMI, ART, and cervical length.
Selective reduction performed by experienced hands for a dizygotic abnormal twin is safe and effective. Gestational age at surgery (<26 weeks) was inversely correlated with gestational age at delivery and positively with the rate of preterm birth. Reduction after 27 weeks, where legal, can be performed with a good outcome for the retained fetus.
本研究旨在评估不同孕周减为单胎的双绒毛膜双羊膜囊双胎妊娠的妊娠结局。
这是一项对2011年至2020年期间在单一三级转诊中心接受减胎术减为单胎的双胎妊娠进行的回顾性队列研究。共纳入433例病例。根据手术时的孕周将队列分为五组：A组：<16周（125例）；B组：16 - 19周（80例）；C组：20 - 23周（74例）；D组：24 - 26周（48例）；E组：≥27周（106例）。通过查阅电子病历或进行访谈获取结局数据。
选择性减胎术在技术上是成功的。研究人群的临床特征无差异。总体活产率和存活率分别为96.5%和95.4%。虽然自然流产率相当，但各组的分娩孕周有显著差异（<0.001）。此外，A、B、C和D组存在分娩孕周随手术孕周增加而降低的趋势，而E组的分娩孕周晚于D组。在A、B、C和D组中，<32周和<34周的早产率随手术孕周增加而升高，而E组的早产率显著低于D组。回归分析表明，在调整产妇年龄、产次、孕前体重指数、辅助生殖技术和宫颈长度后，减胎时机可能是一个独立因素。
由经验丰富的医生对双卵异常双胎进行选择性减胎术是安全有效的。手术孕周（<26周）与分娩孕周呈负相关，与早产率呈正相关。在法律允许的情况下，27周后进行减胎术，对留存胎儿可取得良好结局。
