Clinical characteristics and pregnancy outcomes of multifetal pregnancy reduction:a 12-year cohort study
Objective To analyze the clinical characteristics,pregnancy outcomes and factors affecting live birth of patients undergoing multifetal pregnancy reduction(MFPR),in order to provide reference for clinical strategies.Methods A retrospective cohort study was conducted on all patients who underwent multifetal pregnancy reduction among polychorionic multifetal pregnancy patients at the Center for Reproductive Medicine,Department of Obstetrics and Gynecology of Peking University Third Hospital during a period of 12 years from January 1,2009 to December 31,2020.The overall and annual clinical characteristics were analyzed,pregnancy outcomes were followed up.Patients were divided into live birth group(n=1 555)and not live birth group(n=205),and factors affecting live birth were analyzed by multivariate logistic.Through further subgroup analysis,multiple pregnancies were divided into three subgroups:dichorionic diamniotic twin,triplet pregnancy,and four or more high sequence multiple pregnancy.Results A total of 1 925 patients who underwent MFPR were included,and 1 760 pregnancy outcomes were followed up.In the past 12 years,there had been an increase in dizygotic twins,and the proportion of transabdominal fetal reduction had significantly increased,from 3%in 2009 to 77%in 2020.The annual live birth rate of reduction patients fluctuated between 83%and 94%.The live birth rate of patients with MFPR was related with the type of multiple pregnancies,the method of reducing pregnancies,and the number of retained embryos.The live birth rate of four or more high sequence multiple pregnancies[75.8%(72/95)]was lower than that of dichorionic diamniotic twins[90.0%(796/884),P<0.001],the dichorionic diamniotic twins[89.9%(241/268),P<0.001],the trichorionic triamniotic triplet pregnancy[86.9%(446/513),P=0.005].The live birth rate of transabdominal fetal reduction[91.4%(655/717)]was higher than that of transvaginal fetal reduction with fetal cardiac activity area injection of KCl[84.9%(304/358),P=0.001],and vaginal embryo aspiration[87.0%(596/685),P=0.009].There was no statistically significant difference in the live birth rate between vaginal KCl injection and vaginal aspiration(P=0.351).The survival rate of patients with retained singletons[89.7%(1 062/1 184)]was higher than that of patients with retained twins[85.6%(493/576),P=0.012].After adjusting for confounding factors such as age,assisted pregnancy method,type of multiple pregnancies,and number of retained embryos,transabdominal fetal reduction was an independent protective factor for live birth rate(P=0.040,OR=1.604,95%CI:1.021-2.519).Conclusion With the change of transplantation strategy,the proportion of dichorionic diamniotic twins increased,and the proportion of transabdominal fetal reduction increased,which pregnancy outcomes might be better.There was no difference in pregnancy outcomes between those who underwent vaginal aspiration and transvaginal fetal reduction with fetal cardiac activity area injection of KCl.The outcomes of four or more high sequence multiple pregnancies were poor,and it was necessary to strictly control the number of embryo transfers and optimize ovulation promotion plans in clinical practice.
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