Selective Fetal Reduction of Uncomplicated Dichorionic Twins on Parental Request Versus Ongoing Twins and Pregnancy Outcomes: A Systematic Review and Meta-analysis.
Ioannis Mitrogiannis, Christos Chatzakis, Alexandros Sotiriadis, Stylianos Makrydimas, Alexandros Katrachouras, Athina Efthymiou, George Makrydimas
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引用次数: 0
Abstract
Objective: The aim of this study was to assess the effect of elective fetal reduction in uncomplicated twin pregnancies on maternal-fetal outcomes, compared to ongoing twin pregnancies.
Data sources: PubMed, Scopus (until December 2023), and references of retrieved articles.
Study appraisal and synthesis methods: Quality assessment of observational studies was conducted using the ROBINS-I tool. The overall quality of evidence was evaluated per GRADE. A quantitative analysis was performed for electively reduced dichorionic twins. Primary outcome was preterm birth. Secondary outcomes were gestational age at delivery, stillbirth and neonatal intensive care unit, gestational diabetes mellitus, pre-eclampsia, and pregnancy loss < 24 weeks of gestation. Summary odds ratio (ORs) with 95% confidence intervals (CIs) were calculated, and random-effects models were used for data synthesis.
Results: The initial electronic search yielded 745 studies; 175 studies were further identified from reference citations. Five articles included appropriate data and were finally included in the meta-analysis. All studies were evaluated as "moderate risk of bias". Those five studies reported on dichorionic twins. Elective reduction in dichorionic twins reduces the risk for preterm birth <37 weeks (4 studies; n=1577; OR 0.14, 95% CI 0.09-0.22, moderate-quality evidence), <34 weeks (3 studies; n=1335; OR 0.22, 95% CI 0.07-0.69; low-quality evidence), <32 weeks (3 studies; n=1335; OR 0.31, 95% CI, 0.11-0.88; low-quality evidence), gestational diabetes (3 studies; n= 1410; OR 0.57, 95% CI 0.33-0.97, low-quality evidence), pregnancy-associated hypertensive disorders (2 studies; n=581; OR 0.29, 95% CI 0.10-0.83; low-quality evidence), birthweight <10th centile (2 studies; n=1163; OR 0.27, 95% CI 0.17-0.43; moderate-quality evidence), birthweight< 5th centile (2 studies; n=1163; OR 0.31, 95% CI 0.19-0.50; low-quality evidence) and increases gestational age at delivery {four studies; n= 1362; MD 2.93 weeks, 95% CI 2.08-3.77; moderate-quality evidence}. The risk for stillbirth (2 studies; n= 1311; OR 1.63, 95% CI 0.43-6.21; very low-quality evidence) or pregnancy loss< 24 weeks (3 studies; n=1436; OR 1.20, 95% CI 0.55-2.58; very low-quality evidence) were not statistically significant different.
Conclusions: Compared to ongoing dichorionic twin pregnancies, dichorionic pregnancies that undergo elective selective fetal reduction are associated with lower incidences of preterm birth < 37 weeks, <34 weeks, <32 weeks, birthweight <10th centile and <5th centile, gestational diabetes, hypertensive disorders of pregnancy, and later gestational age at delivery by almost 3 weeks. These associations were often based on very low quality of evidence; so these results should be interpreted with caution and further studies should be conducted.
期刊介绍:
The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including:
Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women.
Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health.
Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child.
Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby.
Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.