Abstract：
To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST).
MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks\' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5-min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale for cohort studies. Random-effects head-to-head meta-analysis was used to analyze the data.
Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10-0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23-0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11-0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05-0.85); P = 0.03). The mean birth weight was significantly greater in the early-ST group (mean difference (MD), 392.2 g (95% CI, 59.1-726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04-4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5-min Apgar score < 7 (P = 0.35) and neonatal survival of the non-reduced twin (P = 0.54).
The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks\' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5-min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale for cohort studies. Random-effects head-to-head meta-analysis was used to analyze the data.
Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10-0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23-0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11-0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05-0.85); P = 0.03). The mean birth weight was significantly greater in the early-ST group (mean difference (MD), 392.2 g (95% CI, 59.1-726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04-4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5-min Apgar score < 7 (P = 0.35) and neonatal survival of the non-reduced twin (P = 0.54).
The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：评估双胎双胎早期和晚期选择性终止妊娠（ST）的结局。
方法：MEDLINE，EMBASE,直到2022年3月，CINAHL和WebofScience数据库都进行了电子搜索。这项研究的主要目的是在24周之前怀孕。次要结局包括早产（PTB）<37、34和32周；早产胎膜早破（pPROM）；分娩时的胎龄（GA）；剖宫产；平均出生体重；5分钟时的Apgar评分<7；总体新生儿发病率和新生儿存活率。只有前瞻性和回顾性研究报告了双胎妊娠早期（<18周）和晚期（>18周）ST的结果数据才被认为适合纳入。纳入研究的质量评估使用纽卡斯尔-渥太华量表进行队列研究。随机效应头对头荟萃分析用于分析数据。
结果：本系统综述包括7项研究，包括646例双胎双胎妊娠。与晚期ST相比，早期双胎双胎妊娠在24周之前流产的风险显着降低（1％vs8％，OR0.25；95%CI0.10-0.65，p=0.004）。考虑PTB<37周时，与ST晚期相比，早期双胎双胎的PTB风险显着降低（19％vs45％，OR0.36；95%CI0.23-0.57，p<0.00001)，<34周（4%vs19%，OR0.24；95%CI0.11-0.54，p=0.0005）和<32周（3%vs20%，OR0.21；95%CI0.05-0.85，p=0.03）。早期ST组的平均出生体重明显更大（MD392.2克；95％CI59.1-726.7，p=0.02），分娩时的平均GA显示出明显的趋势（MD2.47周；95％CI0.04-4.91，p=0.05）。在pPROM方面，与早期ST相比，早期双胎双胎妊娠之间没有显着差异（p=0.27），剖宫产（p=0.38），5分钟时的Apgar评分<7（p=0.35）和未减少的双胞胎的新生儿存活率（p=0.54）。
结论：24周前流产的风险，以及PTB<37、34和32周的发生率，与早期ST相比，晚期双胎双胎妊娠的发生率明显更高，因此强调了双胎妊娠早期诊断胎儿畸形的重要性。本文受版权保护。保留所有权利。
方法：MEDLINE，EMBASE,直到2022年3月，CINAHL和WebofScience数据库都进行了电子搜索。这项研究的主要目的是在24周之前怀孕。次要结局包括早产（PTB）<37、34和32周；早产胎膜早破（pPROM）；分娩时的胎龄（GA）；剖宫产；平均出生体重；5分钟时的Apgar评分<7；总体新生儿发病率和新生儿存活率。只有前瞻性和回顾性研究报告了双胎妊娠早期（<18周）和晚期（>18周）ST的结果数据才被认为适合纳入。纳入研究的质量评估使用纽卡斯尔-渥太华量表进行队列研究。随机效应头对头荟萃分析用于分析数据。
结果：本系统综述包括7项研究，包括646例双胎双胎妊娠。与晚期ST相比，早期双胎双胎妊娠在24周之前流产的风险显着降低（1％vs8％，OR0.25；95%CI0.10-0.65，p=0.004）。考虑PTB<37周时，与ST晚期相比，早期双胎双胎的PTB风险显着降低（19％vs45％，OR0.36；95%CI0.23-0.57，p<0.00001)，<34周（4%vs19%，OR0.24；95%CI0.11-0.54，p=0.0005）和<32周（3%vs20%，OR0.21；95%CI0.05-0.85，p=0.03）。早期ST组的平均出生体重明显更大（MD392.2克；95％CI59.1-726.7，p=0.02），分娩时的平均GA显示出明显的趋势（MD2.47周；95％CI0.04-4.91，p=0.05）。在pPROM方面，与早期ST相比，早期双胎双胎妊娠之间没有显着差异（p=0.27），剖宫产（p=0.38），5分钟时的Apgar评分<7（p=0.35）和未减少的双胞胎的新生儿存活率（p=0.54）。
结论：24周前流产的风险，以及PTB<37、34和32周的发生率，与早期ST相比，晚期双胎双胎妊娠的发生率明显更高，因此强调了双胎妊娠早期诊断胎儿畸形的重要性。本文受版权保护。保留所有权利。
