Fasouliotis S J, Schenker J G
Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel.
Eur J Obstet Gynecol Reprod Biol. 1997 Dec;75(2):183-90. doi: 10.1016/s0301-2115(97)00132-2.
The objective of this work was to evaluate the outcome of multifetal pregnancy reduction and to provide an analysis of the ethical dilemmas associated with its application. The study design was based on data on over 1400 completed pregnancies that underwent multifetal pregnancy reduction as reported in the world literature during 1993-1996. The results were: A total of 1453 completed cases of multifetal pregnancy reduction are presented. The total survival rate was estimated to be 87.7%, resulting in a total pregnancy loss rate of 12.3%. The lowest survival rate is found to be in higher-order pregnancies of five or more fetuses (75.2%), whereas pregnancy loss rate seems to be similar for quadruplets, triplets and twins that underwent reduction (11.3%, 8.3% and 13.6%, respectively). A 33.3% of the total pregnancy loss rate occurred within four weeks from the procedure, whereas 66.7% occurred after the four weeks but at 24 weeks of gestation or earlier. The mean gestational age at delivery was estimated to be 33 weeks for pregnancies reduced to triplets, 35.8 weeks for those reduced to twins and 36.9 weeks for singletons, with 5% delivering at less than 28 weeks and 9.6% at 29-32 weeks. We conclude that multifetal pregnancy reduction has been established as an efficient and safe way to improve outcome of multifetal gestations, especially those with four or more fetuses and likely of triplets. As the experience from the procedure increases, it seems that reduction of triplets to twins can be offered to patients with satisfactory results. The reduction to singletons has not yet been established and is being performed only when medical indications exist. Prenatal genetic diagnosis should become an integral part of counselling on multiple pregnancy. Physicians should take whenever possible measures designed to prevent high multiple birth pregnancies. We also note that although multifetal pregnancy reduction improves significantly the outcome of multiple pregnancies, several ethical dilemmas arising from its application are still under dispute.
这项工作的目的是评估多胎妊娠减胎术的结果，并对其应用中涉及的伦理困境进行分析。该研究设计基于1993年至1996年期间世界文献报道的1400多例完成多胎妊娠减胎术的妊娠数据。结果如下：共呈现1453例完成多胎妊娠减胎术的病例。总存活率估计为87.7%，总妊娠丢失率为12.3%。发现五胎及以上的高阶妊娠存活率最低（75.2%），而接受减胎术的四胞胎、三胞胎和双胞胎的妊娠丢失率似乎相似（分别为11.3%、8.3%和13.6%）。总妊娠丢失率的33.3%发生在手术后四周内，而66.7%发生在四周后但在妊娠24周或更早。减胎为三胞胎的妊娠分娩时的平均孕周估计为33周，减胎为双胞胎的为35.8周，单胎的为36.9周，5%在28周前分娩，9.6%在29 - 32周分娩。我们得出结论，多胎妊娠减胎术已被确立为改善多胎妊娠结局的一种有效且安全的方法，尤其是对于四胎及以上且可能为三胞胎的妊娠。随着该手术经验的增加，似乎可以为患者提供将三胞胎减为双胞胎的手术，结果令人满意。减为单胎的做法尚未确立，仅在有医学指征时进行。产前基因诊断应成为多胎妊娠咨询的一个组成部分。医生应尽可能采取措施预防高多胎妊娠。我们还注意到尽管多胎妊娠减胎术显著改善了多胎妊娠的结局，但其应用引发的一些伦理困境仍存在争议。
