Silver R K, Helfand B T, Russell T L, Ragin A, Sholl J S, MacGregor S N
Division of Maternal-Fetal Medicine, Northwestern University Medical School, Evanston Hospital, Illinois, USA.
Fertil Steril. 1997 Jan;67(1):30-3. doi: 10.1016/s0015-0282(97)81851-1.
To compare pregnancy outcome in twin gestations resulting from multifetal reduction to "primary" twin pregnancies derived from either spontaneous conception or infertility therapy.
Case-control study.
University-affiliated tertiary center.
PATIENT(S): Multifetal pregnancies (quadruplets or more) reduced to twins (group A) compared with twin gestations conceived either spontaneously (group B) or through infertility therapy (group C).
INTERVENTION(S): Multifetal reduction for group A; perinatal care for groups A, B, and C.
MAIN OUTCOME MEASURE(S): Comparison of perinatal complications between groups including antepartum bleeding, premature membrane rupture, and preterm labor. Neonatal outcomes compared including gestational age at delivery, birth weight, incidence of fetal growth restriction, and twin discordancy.
RESULT(S): A higher incidence of idiopathic preterm labor was noted in group A cases (14/18) compared with either of the control groups (B: 26/54, or C: 24/54). As a consequence, group A had the lowest gestational age at delivery (32.6 +/- 3.9 weeks) compared with groups B (33.6 +/- 4.4 weeks) and C (36.0 +/- 3.4 weeks). Corresponding birth weights of both first- and second-born twins were significantly lower in group A compared with group C, whereas the birth weight comparison between groups A and B showed a nonsignificant difference. The proportion of pregnancies in which one or both twins weighted less than the 10th percentile was greatest in group A pregnancies (A: 5/18 versus C: 5/54). Discordant birth weight among twin pairs was proportionately greater for group A cases at both the 20% and 30% discordance levels.
CONCLUSION(S): Twin gestations resulting from multifetal reduction are at increased risk for preterm birth, fetal growth restriction, and discordancy when compared with fertility therapy-derived, nonreduced twins.
比较经多胎减胎术获得的双胎妊娠与自然受孕或不育治疗后的“原发性”双胎妊娠的妊娠结局。
病例对照研究。
大学附属三级中心。
多胎妊娠（四胎及以上）减为双胎（A组），与自然受孕双胎妊娠（B组）或经不育治疗受孕的双胎妊娠（C组）进行比较。
A组进行多胎减胎术；A、B、C组均接受围产期护理。
比较各组围产期并发症，包括产前出血、胎膜早破和早产。比较新生儿结局，包括分娩时的孕周、出生体重、胎儿生长受限发生率和双胎差异。
与对照组（B组：26/54，或C组：24/54）相比，A组病例特发性早产的发生率更高（14/18）。因此，A组分娩时的孕周最低（32.6±3.9周），而B组为（33.6±4.4周），C组为（36.0±3.4周）。与C组相比，A组第一和第二胎双胎的相应出生体重均显著较低，而A组和B组之间的出生体重比较无显著差异。A组妊娠中一个或两个双胎体重低于第10百分位数的妊娠比例最高（A组：5/18，C组：5/54）。在20%和30%差异水平上，A组双胎出生体重差异的比例更大。
与不育治疗获得的未减胎双胎相比，经多胎减胎术获得的双胎妊娠早产、胎儿生长受限和差异的风险增加。
