背景:双胎妊娠具有较高的先天性和结构性畸形风险,妊娠并发症包括流产,死产,和胎儿宫内死亡,与单胎怀孕相比。携带具有严重畸形或异常核型的胎儿会使剩余的健康胎儿处于更高的不良结局和妊娠并发症的风险中。产妇医疗状况或复杂的产科史可能,结合双胎妊娠,会增加女性和胎儿的风险。据我们所知,以前没有研究对所有双胎双胎妊娠的结局进行过评估和比较,也没有在全国队列中对减少双胎与非减少双胎和原发性单胎的结果进行过比较.这些数据对于临床医生在咨询夫妇关于胎儿减少及其影响时很重要。
目的:本研究旨在描述和比较不良妊娠结局的风险,包括怀孕失败的风险,在全国所有二色子减少的双胞胎队列中,非还原,和主要的单身人士。此外,我们研究了胎儿减少时的胎龄对分娩时胎龄的影响.
方法:这是一项对所有丹麦双胎双胎妊娠的回顾性队列研究,包括接受减胎的妊娠和大部分随机选择的预产期为2008年1月至2018年12月的单胎妊娠.主要结局指标是不良妊娠结局(定义为24周前流产,从24周开始死产,或非减少双胎妊娠中的单胎宫内胎儿死亡),早产,和产科妊娠并发症。将胎儿减少后的结局与未减少的双胎双胞胎和原发性单胎的结局进行了比较。
结果:总计,9735双胎双胎妊娠包括在内,其中172人(1.8%)减少。此外,包括16,465个主要的单例。通过经腹针头引导注射氯化钾,在11到23周之间进行胎儿减少,所有病例的结局数据均完整.不良妊娠结局为4.1%(95%置信区间,1.7%-8.2%)双胎妊娠减少,和2.4%(95%置信区间,0.7%-6.1%)在28周前交付,和4.2%(95%置信区间,1.7%-8.5%)前32周。然而,当14周前进行胎儿减少时,不良妊娠结局仅发生在1.4%(95%置信区间,0.0%-7.4%),分娩前28周和32周减少到0%(95%置信区间,0.0%-5.0%)和2.8%(95%置信区间,0.3%-9.7%),分别。相比之下,3.0%(95%置信区间,2.7%-3.4%)的非还原双胎有不良妊娠结局,和1.9%(95%置信区间,1.7%-2.1%)在28周前交付,和7.3%(95%置信区间,6.9%-7.7%)前32周。不良妊娠结局发生率为0.9%(95%置信区间,0.7%-1.0%)的主要单身人士,和0.2%(95%置信区间,0.1%-0.3%)在28周前交付,和0.7%(95%置信区间,0.6%-0.9%)前32周。对于减少的双胞胎,在考虑了母亲因素和病史后,证明胎儿减少的时间越晚,交货时间越早(P<0.01)。减少双胎妊娠的妊娠并发症总体风险明显低于非减少双胎妊娠(P=0.02)。
结论:在包括所有双胎双胎妊娠的全国11年队列中,针对胎儿或产妇的指征,通过针引导经腹减胎被证明是安全的,剩下的双胞胎有很好的结果。当手术在14周前进行时,结果最好。
Twin pregnancies carry a higher risk of congenital and structural malformations, and pregnancy complications including miscarriage, stillbirth, and intrauterine fetal death, compared with singleton pregnancies. Carrying a fetus with severe malformations or abnormal karyotype places the remaining healthy fetus at an even higher risk of adverse outcome and pregnancy complications. Maternal medical conditions or complicated obstetrical history could, in combination with twin pregnancy, cause increased risks for both the woman and the fetuses. To our knowledge, no previous studies have evaluated and compared the outcomes of all dichorionic twin pregnancies and compared the results of reduced twins with those of nonreduced and primary singletons in a national cohort. These data are important for clinicians when counseling couples about fetal reduction and its implications.
This
study aimed to describe and compare the risks of adverse pregnancy outcomes, including the risk of pregnancy loss, in a national cohort of all dichorionic twins-reduced, nonreduced, and primary singletons. In addition, we examined the implications of gestational age at fetal reduction on gestational age at delivery.
This was a retrospective cohort
study of all Danish dichorionic twin pregnancies, including pregnancies undergoing fetal reduction and a large proportion of randomly selected primary singleton pregnancies with due dates between January 2008 and December 2018. The primary outcome measures were adverse pregnancy outcomes (defined as miscarriage before 24 weeks, stillbirth from 24 weeks, or single intrauterine fetal death in nonreduced twin pregnancies), preterm delivery, and obstetrical pregnancy complications. Outcomes after fetal reduction were compared with those of nonreduced dichorionic twins and primary singletons.
In total, 9735 dichorionic twin pregnancies were included, of which 172 (1.8%) were reduced. In addition, 16,465 primary singletons were included. Fetal reductions were performed between 11 and 23 weeks by transabdominal needle-guided injection of potassium chloride, and outcome data were complete for all cases. Adverse pregnancy outcome was observed in 4.1% (95% confidence interval, 1.7%-8.2%) of reduced twin pregnancies, and 2.4% (95% confidence interval, 0.7%-6.1%) were delivered before 28 weeks, and 4.2% (95% confidence interval, 1.7%-8.5%) before 32 weeks. However, when fetal reduction was performed before 14 weeks, adverse pregnancy outcomes occurred in only 1.4% (95% confidence interval, 0.0%-7.4%), and delivery before 28 and 32 weeks diminished to 0% (95% confidence interval, 0.0%-5.0%) and 2.8% (95% confidence interval, 0.3%-9.7%), respectively. In contrast, 3.0% (95% confidence interval, 2.7%-3.4%) of nonreduced dichorionic twins had an adverse pregnancy outcome, and 1.9% (95% confidence interval, 1.7%-2.1%) were delivered before 28 weeks, and 7.3% (95% confidence interval, 6.9%-7.7%) before 32 weeks. Adverse pregnancy outcomes occurred in 0.9% (95% confidence interval, 0.7%-1.0%) of primary singletons, and 0.2% (95% confidence interval, 0.1%-0.3%) were delivered before 28 weeks, and 0.7% (95% confidence interval, 0.6%-0.9%) before 32 weeks. For reduced twins, after taking account of maternal factors and medical history, it was demonstrated that the later the fetal reduction was performed, the earlier the delivery occurred (P<.01). The overall risk of pregnancy complications was significantly lower among reduced twin pregnancies than among nonreduced dichorionic twin pregnancies (P=.02).
In a national 11-year cohort including all dichorionic twin pregnancies, transabdominal fetal reduction by needle guide for fetal or maternal indication was shown to be safe, with good outcomes for the remaining co-twin. Results were best when the procedure was performed before 14 weeks.