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Abstract：
BACKGROUND: It is generally beneficial and recommended that dichorionic triamniotic (DCTA) triplet pregnancies be reduced to monochorionic (MC) twin or singleton pregnancies after assisted reproductive technology (ART). However, some infertile couples still have a firm desire to retain twins. For this reason, the best foetal reduction strategies need to be available for infertile couples and clinicians. Given that data on the elective reduction of DCTA triplet pregnancies to twin pregnancies are scarce, we investigated the outcomes of elective reduction of DCTA triplet pregnancies through the retrospective analysis of previous data.
METHODS: Patients with DCTA triplet pregnancies who underwent elective foetal reduction between January 2012 and June 2020 were recruited. A total of 67 eligible patients with DCTA triplet pregnancies were divided into two groups: a DCTA-to-dichorionic diamniotic (DCDA) twin group (n = 38) and a DCTA-to-monochorionic diamniotic (MCDA) twin group (n = 29); the basic clinical data of the two groups were collected for comparison.
RESULTS: Compared with the DCDA-to-MCDA twin group, the DCTA-to-DCDA twin group had lower rates of complete miscarriage (7.89% versus 31.03%, p = 0.014), early complete miscarriage (5.26% versus 24.14%, p = 0.034), late preterm birth (25.71% versus 65.00%, p = 0.009) and very low birth weight (0 versus 11.11%, p = 0.025). In addition, the DCTA-to-DCDA twin group had higher rates of full-term delivery (65.71% versus 25.00%, p = 0.005), survival (92.11% versus 68.97%, p = 0.023), and taking the babies home (92.11% versus 68.97%, p = 0.023) than did the DCTA-to-MCDA twin group. In terms of neonatal outcomes, a significantly greater gestational age (38.06 ± 2.39 versus 36.28 ± 2.30, p = 0.009), average birth weight (3020.77 ± 497.33 versus 2401.39 ± 570.48, p < 0.001), weight of twins (2746.47 ± 339.64 versus 2251.56 ± 391.26, p < 0.001), weight of the larger neonate (2832.94 ± 320.58 versus 2376.25 ± 349.95, p < 0.001) and weight of the smaller neonate (2660.00 ± 345.34 versus 2126.88 ± 400.93, p < 0.001) was observed in the DCTA-to-DCDA twin group compared to the DCTA-to-MCDA twin group.
CONCLUSIONS: The DCTA-to-DCDA twin group had better pregnancy and neonatal outcomes than the DCTA-to-MCDA twin group. This reduction approach may be beneficial for patients with dichorionic triamniotic triplet pregnancies who have a strong desire to have DCDA twins.
METHODS: Patients with DCTA triplet pregnancies who underwent elective foetal reduction between January 2012 and June 2020 were recruited. A total of 67 eligible patients with DCTA triplet pregnancies were divided into two groups: a DCTA-to-dichorionic diamniotic (DCDA) twin group (n = 38) and a DCTA-to-monochorionic diamniotic (MCDA) twin group (n = 29); the basic clinical data of the two groups were collected for comparison.
RESULTS: Compared with the DCDA-to-MCDA twin group, the DCTA-to-DCDA twin group had lower rates of complete miscarriage (7.89% versus 31.03%, p = 0.014), early complete miscarriage (5.26% versus 24.14%, p = 0.034), late preterm birth (25.71% versus 65.00%, p = 0.009) and very low birth weight (0 versus 11.11%, p = 0.025). In addition, the DCTA-to-DCDA twin group had higher rates of full-term delivery (65.71% versus 25.00%, p = 0.005), survival (92.11% versus 68.97%, p = 0.023), and taking the babies home (92.11% versus 68.97%, p = 0.023) than did the DCTA-to-MCDA twin group. In terms of neonatal outcomes, a significantly greater gestational age (38.06 ± 2.39 versus 36.28 ± 2.30, p = 0.009), average birth weight (3020.77 ± 497.33 versus 2401.39 ± 570.48, p < 0.001), weight of twins (2746.47 ± 339.64 versus 2251.56 ± 391.26, p < 0.001), weight of the larger neonate (2832.94 ± 320.58 versus 2376.25 ± 349.95, p < 0.001) and weight of the smaller neonate (2660.00 ± 345.34 versus 2126.88 ± 400.93, p < 0.001) was observed in the DCTA-to-DCDA twin group compared to the DCTA-to-MCDA twin group.
CONCLUSIONS: The DCTA-to-DCDA twin group had better pregnancy and neonatal outcomes than the DCTA-to-MCDA twin group. This reduction approach may be beneficial for patients with dichorionic triamniotic triplet pregnancies who have a strong desire to have DCDA twins.
摘要：
背景：在辅助生殖技术（ART）后，通常有益并建议将双胎羊膜（DCTA）三胎妊娠减少为单胎（MC）双胎或单胎妊娠。然而,一些不育夫妇仍然有坚定的愿望留住双胞胎。出于这个原因,最好的胎儿减少策略需要为不育夫妇和临床医生提供。鉴于有关将DCTA三胎妊娠选择性减少为双胎妊娠的数据很少，我们通过对以往数据的回顾性分析,调查了选择性减少DCTA三胎妊娠的结局.
方法：招募在2012年1月至2020年6月期间接受选择性胎儿复位术的DCTA三胎妊娠患者。将67例符合条件的DCTA三胎妊娠患者分为两组：DCTA-二胎双胎（DCDA）双胎组（n=38）和DCTA-单胎双胎（MCDA）双胎组（n=29）；收集两组的基本临床资料进行比较。
结果：与DCDA至MCDA双胞胎组相比，DCTA至DCDA双胞胎组的完全流产率较低（7.89%对31.03%，p=0.014),早期完全流产(5.26%对24.14%，p=0.034),晚期早产（25.71%对65.00%，p=0.009）和非常低的出生体重（0对11.11％，p=0.025)。此外,DCTA至DCDA双胞胎组的足月分娩率更高（65.71％对25.00％，p=0.005),生存率（92.11%对68.97%，p=0.023),并将婴儿带回家(92.11%对68.97%，p=0.023）比DCTA至MCDA双胞胎组。就新生儿结局而言，孕龄明显更大（38.06±2.39vs36.28±2.30，p=0.009），平均出生体重（3020.77±497.33对2401.39±570.48，p<0.001），双胞胎的体重（2746.47±339.64对2251.56±391.26，p<0.001），与DCTA至MCDA双胞胎组相比,观察到较大新生儿的体重(2832.94±320.58对2376.25±349.95,p<0.001)和较小新生儿的体重(2660.00±345.34对2126.88±400.93,p<0.001)。
结论：DCTA-DCDA双胎组的妊娠和新生儿结局优于DCTA-MCDA双胎组。这种减少方法对于强烈希望拥有DCDA双胞胎的双胎羊膜三胎妊娠患者可能是有益的。
方法：招募在2012年1月至2020年6月期间接受选择性胎儿复位术的DCTA三胎妊娠患者。将67例符合条件的DCTA三胎妊娠患者分为两组：DCTA-二胎双胎（DCDA）双胎组（n=38）和DCTA-单胎双胎（MCDA）双胎组（n=29）；收集两组的基本临床资料进行比较。
结果：与DCDA至MCDA双胞胎组相比，DCTA至DCDA双胞胎组的完全流产率较低（7.89%对31.03%，p=0.014),早期完全流产(5.26%对24.14%，p=0.034),晚期早产（25.71%对65.00%，p=0.009）和非常低的出生体重（0对11.11％，p=0.025)。此外,DCTA至DCDA双胞胎组的足月分娩率更高（65.71％对25.00％，p=0.005),生存率（92.11%对68.97%，p=0.023),并将婴儿带回家(92.11%对68.97%，p=0.023）比DCTA至MCDA双胞胎组。就新生儿结局而言，孕龄明显更大（38.06±2.39vs36.28±2.30，p=0.009），平均出生体重（3020.77±497.33对2401.39±570.48，p<0.001），双胞胎的体重（2746.47±339.64对2251.56±391.26，p<0.001），与DCTA至MCDA双胞胎组相比,观察到较大新生儿的体重(2832.94±320.58对2376.25±349.95,p<0.001)和较小新生儿的体重(2660.00±345.34对2126.88±400.93,p<0.001)。
结论：DCTA-DCDA双胎组的妊娠和新生儿结局优于DCTA-MCDA双胎组。这种减少方法对于强烈希望拥有DCDA双胞胎的双胎羊膜三胎妊娠患者可能是有益的。
