Reproductive Medicine Centre, Huzhou Maternity & Child Health Care Hospital, Huzhou City, China.
J Obstet Gynaecol. 2024 Dec;44(1):2371955. doi: 10.1080/01443615.2024.2371955. Epub 2024 Jul 8.
Foetal reduction, which involves selectively terminating one or more foetuses in a multiple gestation pregnancy, has become more common. This systematic review and meta-analysis aims to assess and compare pregnancy outcomes of foetal reduction from twin to singleton gestation to ongoing twin gestations.
A comprehensive search of electronic databases (MEDLINE, EMbase, Cochrane Library, CINAHL and PsycINFO) was done for studies published until 15 April 2023. The outcomes analysed included gestational diabetes mellitus (DM), hypertension, caesarean delivery, foetal loss, perinatal death, preterm birth (PTB), intrauterine growth restriction (IUGR), preterm prelabour rupture of membranes (PPROM) and birth weight.
A total of 13 studies comprising 1241 cases of twin to singleton foetal reduction gestation were compared to 20,693 ongoing twin gestations. Our findings indicate that foetal reduction was associated with a significantly lower risk of developing maternal gestational DM (odds ratio [OR] = 0.40, 95% confidence interval [CI] 0.27-0.59) and hypertension (OR = 0.36, 95% CI 0.23-0.57) compared to the control group. Incidence rate of caesarean delivery (OR = 0.65, 95% CI 0.53-0.81) after foetal reduction was significantly lower compared to ongoing twin gestations. There was a 63% lower chance of PTB before 37 weeks of pregnancy. However, there was no significant association between foetal reduction and outcomes such as foetal loss, perinatal death, IUGR and PPROM.
Our findings suggest that foetal twin to singleton reduction entails potential benefits as compared to ongoing twin gestations. Further well planned studies are needed to explore underlying mechanisms to understanding of the outcomes associated with foetal reduction procedures and inform clinical decision-making for pregnant individuals and healthcare providers alike.
选择性终止多胎妊娠中的一个或多个胎儿的胎儿减少已变得更为常见。本系统评价和荟萃分析旨在评估和比较从双胎妊娠到单胎妊娠的胎儿减少与持续双胎妊娠的妊娠结局。
对截至 2023 年 4 月 15 日发表的研究进行了全面的电子数据库（MEDLINE、EMbase、Cochrane 图书馆、CINAHL 和 PsycINFO）检索。分析的结局包括妊娠期糖尿病（DM）、高血压、剖宫产、胎儿丢失、围产儿死亡、早产（PTB）、宫内生长受限（IUGR）、未足月胎膜早破（PPROM）和出生体重。
共有 13 项研究包括 1241 例双胎减胎妊娠，与 20693 例持续双胎妊娠进行了比较。我们的研究结果表明，与对照组相比，胎儿减少与发生母体妊娠期 DM（优势比 [OR] = 0.40，95%置信区间 [CI] 0.27-0.59）和高血压（OR = 0.36，95% CI 0.23-0.57）的风险显著降低。与持续双胎妊娠相比，胎儿减少后的剖宫产发生率（OR = 0.65，95% CI 0.53-0.81）显著降低。妊娠 37 周前早产的几率降低了 63%。然而，胎儿减少与胎儿丢失、围产儿死亡、IUGR 和 PPROM 等结局之间没有显著关联。
我们的研究结果表明，与持续双胎妊娠相比，胎儿双胎减胎具有潜在的益处。需要进一步进行精心设计的研究，以探索潜在机制，了解与胎儿减少手术相关的结局，并为孕妇和医疗保健提供者提供临床决策信息。
