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Tytuł:
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Clinical outcomes in higher-order multiples reduced to dichorionic diamniotic (DCDA) twins compared with primary twins and singletons: A prospective observational study.
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Autorzy:
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Singh C; Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India.
Thakur S; Department of Medical Genetics and Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India.
Shahnaz G; Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India.
Dagar S; Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India.
Shastri A; Department of Fetal Medicine, Madhukar Rainbow Children's Hospital, New Delhi, India.
Khurana D; Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, India.
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Źródło:
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International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2022 Jun; Vol. 157 (3), pp. 671-676. Date of Electronic Publication: 2021 Sep 12.
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Typ publikacji:
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Journal Article; Observational Study
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Język:
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English
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Imprint Name(s):
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Publication: 2017- : Malden, MA : Wiley
Original Publication: [New York, NY] Hoeber Medical Division, Harper & Row, [c1969-
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MeSH Terms:
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Pregnancy Reduction, Multifetal*/adverse effects
Pregnancy Reduction, Multifetal*/methods
Pregnancy, Twin*
Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Twins, Dizygotic
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References:
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Committee on Ethics. Multifetal pregnancy reduction. Committee opinion no. 719. Obstet Gynecol. 2017;130:e158-63.
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Gupta P, Faridi MM, Goel N, Zaidi ZH. Reappraisal of twinning: epidemiology and outcome in the early neonatal period. Singapore Med J. 2014;55(6):310-317.
National Institute for Health and Care Excellence. Twin and triplet pregnancy [Nice Guideline No. 137]. 2019. https://www.nice.org.uk/guidance/ng137.
American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. ACOG Practice bulletin no. 144. Obstet Gynecol. 2014;123:1118-1132.
Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013;41(1):102-113.
Khalil A, Rodgers M, Baschat A, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;47(2):247-263. Erratum in: Ultrasound Obstet Gynecol. 2018 Jul;52(1):140.
Dodd JM, Dowswell T, Crowther CA. Reduction of the number of fetuses for women with a multiple pregnancy. Cochrane Database Syst Rev. 2015;11:CD003932.
Anthoulakis C, Dagklis T, Mamopoulos A, Athanasiadis A. Risks of miscarriage or preterm delivery in trichorionic and dichorionic triplet pregnancies with embryo reduction versus expectant management: a systematic review and meta-analysis. Hum Reprod. 2017;32(6):1351-1359.
Evans MI, Andriole S, Britt DW. Fetal reduction: 25 years’ experience. Fetal Diagn Ther. 2014;35(2):69-82.
Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH. Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod. 2006;21:1912-1917.
Ata B, Rasillo LJ, Sukhdeo S, Son WY, Tan SL, Dahan MH. Obstetric out- comes of IVF trichorionic triamniotic triplets which are spontaneously or electively reduced to twins. J Assist Reprod Genet. 2011;28:1217-1222.
Chaveeva P, Kosinski P, Puglia D, Poon LC, Nicolaides KH. Trichorionic and dichorionic triplet pregnancies at 10-14 weeks: outcome after embryo reduction compared to expectant management. Fetal Diagn Ther. 2013;34(4):199-205.
Wimalasundera RC. Selective reduction and termination of multiple pregnancies. Semin Fetal Neonatal Med. 2010;15:327-335.
Evans MI, Berkowitz RL, Wapner RJ, et al. Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol. 2001;184(2):97-103.
van de Mheen L, Everwijn SMP, Knapen MFCM, et al. The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. Am J Obstet Gynecol. 2014;210(536):e1-6.
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Contributed Indexing:
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Keywords: fetal reduction; higher-order multiple gestation; multifetal pregnancy; multiple pregnancy; perinatal outcome; prematurity
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Entry Date(s):
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Date Created: 20210830 Date Completed: 20220517 Latest Revision: 20220517
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Update Code:
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20240105
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DOI:
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10.1002/ijgo.13901
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PMID:
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34460958
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Objective: To compare outcomes in higher-order multiple pregnancies reduced to dichorionic diamniotic (DCDA) twins with primary DCDA twins and singleton pregnancies.
Methods: This prospective observational study included all higher-order multiple pregnancies that underwent ultrasound-guided transabdominal fetal reduction at 11-13 weeks of gestation from January 2018 to June 2020. Outcomes were compared with 100 primary DCDA twins and 1078 singletons.
Results: Sixty-four higher-order multiples underwent reduction at mean gestational age of 11.46 weeks. Of the reduced pregnancies, 3.12% resulted in miscarriage before 24 weeks compared with 2% (2/100) of primary twins and 0.74% of singletons (P = 0.09). The mean gestational age at delivery was 33.48 weeks for reduced twins, 34.52 weeks for primary twins (P = 0.10) and 38.14 weeks for singletons (P < 0.001). Compared with primary twins, the adjusted odds of preterm delivery before 34 weeks and before 36 weeks for reduced twins were 0.56 (95% confidence interval [CI] 0.48-3.54, P = 0.62) and 0.84 (95% CI 0.78-8.85, P = 0.08), respectively. There was no significant difference in rates of pre-eclampsia, Cesarean delivery, birth weight below the 10th and 3rd centiles, and perinatal mortality among primary and reduced twins. All risks were significantly lower in singleton pregnancies.
Conclusion: Reduced twins have similar obstetric and perinatal outcomes as primary twins, but adverse outcomes are significantly higher in both groups when compared with singleton pregnancies.
(© 2021 International Federation of Gynecology and Obstetrics.)