Pregnancy outcomes of foetal reduction from twin to singleton gestation compared to ongoing twin gestations: a systematic review and meta-analysis.

IF 0.9 4区医学 Q4 OBSTETRICS & GYNECOLOGY Journal of Obstetrics and Gynaecology Pub Date : 2024-12-01 Epub Date: 2024-07-08 DOI:10.1080/01443615.2024.2371955

Bijun Mao, Li Chen

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Abstract

Background: Foetal reduction, which involves selectively terminating one or more foetuses in a multiple gestation pregnancy, has become more common. This systematic review and meta-analysis aims to assess and compare pregnancy outcomes of foetal reduction from twin to singleton gestation to ongoing twin gestations.

Methods: A comprehensive search of electronic databases (MEDLINE, EMbase, Cochrane Library, CINAHL and PsycINFO) was done for studies published until 15 April 2023. The outcomes analysed included gestational diabetes mellitus (DM), hypertension, caesarean delivery, foetal loss, perinatal death, preterm birth (PTB), intrauterine growth restriction (IUGR), preterm prelabour rupture of membranes (PPROM) and birth weight.

Results: A total of 13 studies comprising 1241 cases of twin to singleton foetal reduction gestation were compared to 20,693 ongoing twin gestations. Our findings indicate that foetal reduction was associated with a significantly lower risk of developing maternal gestational DM (odds ratio [OR] = 0.40, 95% confidence interval [CI] 0.27-0.59) and hypertension (OR = 0.36, 95% CI 0.23-0.57) compared to the control group. Incidence rate of caesarean delivery (OR = 0.65, 95% CI 0.53-0.81) after foetal reduction was significantly lower compared to ongoing twin gestations. There was a 63% lower chance of PTB before 37 weeks of pregnancy. However, there was no significant association between foetal reduction and outcomes such as foetal loss, perinatal death, IUGR and PPROM.

Conclusions: Our findings suggest that foetal twin to singleton reduction entails potential benefits as compared to ongoing twin gestations. Further well planned studies are needed to explore underlying mechanisms to understanding of the outcomes associated with foetal reduction procedures and inform clinical decision-making for pregnant individuals and healthcare providers alike.

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从双胎妊娠减胎至单胎妊娠与持续双胎妊娠的妊娠结局比较：系统综述和荟萃分析。

背景：减胎术是指在多胎妊娠中选择性终止一个或多个胎儿的妊娠。本系统综述和荟萃分析旨在评估和比较从双胎妊娠到单胎妊娠再到双胎妊娠的胎儿减胎术的妊娠结局：方法：全面检索电子数据库（MEDLINE、EMbase、Cochrane Library、CINAHL 和 PsycINFO）中截至 2023 年 4 月 15 日发表的研究。分析的结果包括妊娠期糖尿病（DM）、高血压、剖腹产、胎儿丢失、围产期死亡、早产（PTB）、宫内生长受限（IUGR）、产前胎膜早破（PPROM）和出生体重：共有 13 项研究，包括 1241 例双胎转单胎减胎妊娠与 20693 例持续双胎妊娠进行了比较。我们的研究结果表明，与对照组相比，减胎术与产妇妊娠糖尿病（几率比[OR] = 0.40，95%置信区间[CI] 0.27-0.59）和高血压（OR = 0.36，95%置信区间[CI] 0.23-0.57）的发病风险显著降低有关。与双胎妊娠相比，减胎后剖腹产的发生率（OR = 0.65，95% CI 0.53-0.81）明显降低。妊娠 37 周前发生先兆流产的几率降低了 63%。然而，减胎与胎儿丢失、围产期死亡、IUGR和PPROM等结果之间没有明显关联：我们的研究结果表明，与双胎妊娠相比，胎儿减胎对单胎妊娠有潜在的益处。我们需要进一步开展计划周密的研究，探索了解胎儿减胎术相关结果的潜在机制，并为孕妇和医疗保健提供者的临床决策提供信息。

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来源期刊

Journal of Obstetrics and Gynaecology 医学-妇产科学

CiteScore

2.40

自引率

7.70%

发文量

398

审稿时长

6 months

期刊介绍： Journal of Obstetrics and Gynaecology represents an established forum for the entire field of obstetrics and gynaecology, publishing a broad range of original, peer-reviewed papers, from scientific and clinical research to reviews relevant to practice. It also includes occasional supplements on clinical symposia. The journal is read widely by trainees in our specialty and we acknowledge a major role in education in Obstetrics and Gynaecology. Past and present editors have recognized the difficulties that junior doctors encounter in achieving their first publications and spend time advising authors during their initial attempts at submission. The journal continues to attract a world-wide readership thanks to the emphasis on practical applicability and its excellent record of drawing on an international base of authors.