多胎妊娠减少是一种用于减少胎儿数量以减轻与多胎妊娠相关的不良结局风险的技术。单绒毛膜羊膜双胎妊娠有独特的并发症,导致不良妊娠结局。因此,患者可以选择选择性减少1个胎儿以改善结局.
本研究旨在比较通过射频消融选择性减少单绒毛膜双胎与计划中的单绒毛膜双胎的结果。
我们对1个机构内的315例单绒毛膜羊膜双胎妊娠进行了回顾性回顾。将计划的选择性减少的双胞胎与正在进行的单绒毛膜羊膜双胞胎进行比较。所有减少均通过将脐带插入部位射频消融至胎儿腹部进行。主要结局为妊娠<36周早产。次要结局包括分娩时的胎龄;早产小于37-,34-,32-,妊娠28周;意外损失;和不良围产期结局。
在315例单绒毛膜羊膜妊娠中,14例(4.4%)接受选择性多胎减胎术,和301(95.6%)是计划中的双胞胎。选择性多胎减胎术组射频消融的平均孕龄为15.1±0.68周。接受选择性多胎减胎术的患者的母亲年龄明显较高(P<.01),并且更可能是亚洲人(P<.01)。此外,他们更有可能经历了体外受精(P=.03)和绒毛膜绒毛取样(P<.01)。选择性射频消融组的足月分娩率明显高于持续双胎(胎龄,38周[四分位数范围,36.1-39.1]vs35.9周[四分位数间距,34.0-36.9];P<0.01)。持续妊娠的患者在妊娠<36周时有早产率增加的趋势(比值比,3.4;95%置信区间,1.0-12.0;P=.06),妊娠<37周时早产风险显著增加(比值比,8.0;95%置信区间,2.4-26.4;P<.01),小于34-没有区别,32-,或妊娠28周。所有接受选择性射频消融的患者均成功怀孕,无妊娠损失或终止。正在进行的妊娠,36个必需的程序,包括16例(5.3%)医学表明的射频消融,14(4.6%)激光烧蚀,和6次(1.9%)羊膜减量。此外,22例(7.3%)计划进行中的双胞胎在<24周妊娠时总妊娠丢失。值得注意的是,在正在进行的妊娠队列中,12例患者(4.0%)在妊娠24周前意外丢失了1个胎儿,12例患者(4.0%)在妊娠24周前有两个胎儿意外丢失。此外,持续妊娠组中有5例(1.7%)在妊娠>24周时宫内胎儿死亡,有10例(3.3%)选择性终止了两个胎儿。2组丢失率差异无统计学意义。
在这项对单绒毛膜双胎的研究中,选择接受多胎减胎术的患者在<37周时的早产率显著较低,而在<36周时的早产趋势较低,而妊娠丢失的风险没有增加.选择性多胎妊娠减少组(38周)的分娩中位胎龄明显高于持续妊娠组(35.9周)。需要进一步的研究来阐明减少多胎妊娠是否能改善长期结局。
Multifetal pregnancy reduction is a technique used to reduce the fetal number to mitigate the risks of adverse outcomes associated with multiple gestations. Monochorionic diamniotic twin pregnancies are subject to unique complications, contributing to adverse pregnancy outcomes. Thus, patients have an option to electively reduce 1 fetus to improve outcomes.
This study aimed to compare outcomes of elective reduction of monochorionic diamniotic twins by radiofrequency ablation to planned ongoing monochorionic diamniotic twins.
We performed a retrospective review of 315 monochorionic diamniotic twin gestations that underwent first-trimester ultrasound within 1 institution. Planned electively reduced twins were compared with ongoing monochorionic diamniotic twins. All reductions were performed via radiofrequency ablation of the cord insertion site into the fetal abdomen. The primary outcome was preterm birth at <36 weeks\' gestation. Secondary outcomes included gestational age at delivery; preterm birth at less than 37-, 34-, 32-, and 28-weeks\' gestation; unintended loss; and adverse perinatal outcomes.
Among 315 monochorionic diamniotic pregnancies, 14 (4.4%) underwent elective multifetal pregnancy reduction, and 301 (95.6%) were planned ongoing twins. The mean gestational age of radiofrequency ablation in the elective multifetal pregnancy reduction group was 15.1±0.68 weeks. Patients who underwent elective multifetal pregnancy reduction had significantly higher maternal age (P<.01) and were more likely to be Asian (P<.01). Moreover, they were more likely to have undergone in vitro fertilization (P=.03) and chorionic villus sampling (P<.01). There was a significantly higher rate of term deliveries in the elective radiofrequency ablation group compared with ongoing twins (gestational age, 38 weeks [interquartile range, 36.1-39.1] vs 35.9 weeks [interquartile range, 34.0-36.9]; P<.01). Patients with ongoing pregnancies had a trend of increased rate of preterm birth at <36 weeks\' gestation (odds ratio, 3.4; 95% confidence interval, 1.0-12.0; P=.06), a significantly increased risk of preterm birth at <37 weeks\' gestation (odds ratio, 8.0; 95% confidence interval, 2.4-26.4; P<.01), and no difference at less than 34-, 32-, or 28- weeks\' gestation. All patients who underwent elective radiofrequency ablation had successful pregnancies with no pregnancy losses or terminations. Of ongoing gestations, 36 required procedures, including 16 (5.3%) medically indicated radiofrequency ablation, 14 (4.6%) laser ablation, and 6 (1.9%) amnioreductions. Furthermore, 22 patients (7.3%) with planned ongoing twins had total pregnancy loss at <24 weeks\' gestation. Notably, 12 patients (4.0%) had unintended loss of 1 fetus before 24 weeks\' gestation in the ongoing pregnancy cohort, and 12 patients (4.0%) had unintended loss of both fetuses before 24 weeks\' gestation. Moreover, 5 patients (1.7%) in the ongoing pregnancy group had intrauterine fetal demise at >24 weeks\' gestation and 10 patients (3.3%) electively terminated both fetuses. There was no significant difference in loss rates between the 2 groups.
In this study of monochorionic diamniotic twins, patients who elected to undergo multifetal pregnancy reduction had significantly lower rates of preterm birth at <37 weeks and a lower trend of preterm birth at <36 weeks\' gestation without an increased risk of pregnancy loss. Median gestational age at delivery was significantly higher in the elective multifetal pregnancy reduction group (38 weeks) than in the ongoing pregnancy group (35.9 weeks). Further research is needed to clarify if multifetal pregnancy reduction improves long-term outcomes.