Fertility and sterility · 2010
Spontaneous reduction before 12 weeks' gestation and selective reduction similarly extend time to delivery in in vitro fertilization of trichorionic-triamniotic triplets.
Оценочное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Skiadas Christine C, Missmer Stacey A, Benson Carol B, Acker David, Racowsky Catherine
Аннотация
OBJECTIVE: To determine the prevalence and the relative benefits conferred by selective and spontaneous reduction of one or more fetuses in trichorionic triamniotic triplet pregnancies on time to delivery.
DESIGN: Retrospective cohort study.
SETTING: Academic medical center.
PATIENT(S): IVF patients with trichorionic triamniotic triplets between January 1998 and December 2007.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Gestational length at time of delivery.
RESULT(S): Selective reduction to twins was used in 87 of the 153 (56.9%) triplet pregnancies that did not spontaneously reduce prior to <12 weeks, and was associated with longer gestation (13.9 days) with a fourfold greater likelihood of delivery at ≥ 34 weeks' gestation (odds ratio [OR], 4.3; 95% confidence interval [CI] = 2.2-8.6), compared with pregnancies not undergoing selective reduction. Compared with ongoing triplets, spontaneous reduction at <12 weeks' gestation (28 cases) was associated with longer gestation (13.7 days) and significantly greater likelihood delivering at or after 34 weeks' gestation (OR, 3.7; 95% CI, 1.4-9.9).
CONCLUSION(S): Selective reduction of one fetus was used in 56.9% of patients in this population. Early spontaneous reduction (<12 weeks) and selective reduction to twins each conferred similar benefits by extending time to delivery and increasing the likelihood of delivery at or after 34 weeks' gestation.
DESIGN: Retrospective cohort study.
SETTING: Academic medical center.
PATIENT(S): IVF patients with trichorionic triamniotic triplets between January 1998 and December 2007.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Gestational length at time of delivery.
RESULT(S): Selective reduction to twins was used in 87 of the 153 (56.9%) triplet pregnancies that did not spontaneously reduce prior to <12 weeks, and was associated with longer gestation (13.9 days) with a fourfold greater likelihood of delivery at ≥ 34 weeks' gestation (odds ratio [OR], 4.3; 95% confidence interval [CI] = 2.2-8.6), compared with pregnancies not undergoing selective reduction. Compared with ongoing triplets, spontaneous reduction at <12 weeks' gestation (28 cases) was associated with longer gestation (13.7 days) and significantly greater likelihood delivering at or after 34 weeks' gestation (OR, 3.7; 95% CI, 1.4-9.9).
CONCLUSION(S): Selective reduction of one fetus was used in 56.9% of patients in this population. Early spontaneous reduction (<12 weeks) and selective reduction to twins each conferred similar benefits by extending time to delivery and increasing the likelihood of delivery at or after 34 weeks' gestation.