Objective

This systematic review and meta-analysis aimed to compare the perinatal outcomes of complicated monochorionic pregnancies after selective reduction by radiofrequency ablation, bipolar cord coagulation, and interstitial laser.

Data Sources

We searched PubMed, Scopus, and Web of Science, from the inception of the database up to April 26, 2021.

Study Eligibility Criteria

Studies comparing at least 2 selective reduction techniques among complicated monochorionic pregnancies and presenting data on perinatal outcomes, including gestational age at procedure, gestational age at delivery, procedure to delivery interval, preterm premature rupture of membranes, preterm birth, survival rate, and birthweight, were eligible.

Methods

The random-effects model was used to pool the mean differences or odds ratios and corresponding 95% confidence intervals. Heterogeneity was assessed using the I² value.

Results

A total of 10 studies with 734 cases of fetal reduction met the inclusion criteria, of which 9 studies with 674 fetuses were eligible for quantitative synthesis. In 8 studies that compared radiofrequency ablation with bipolar cord coagulation, radiofrequency ablation was associated with increased procedure to delivery interval (days) (mean difference, 13.42; 95% confidence interval, 1.90–24.94; P=.02; I²=0.0%), decreased preterm birth (odds ratio, 0.50; 95% confidence interval, 0.29–0.85; P=.01; I²=3.0%), and decreased preterm premature rupture of membranes (odds ratio, 0.45; 95% confidence interval, 0.27–0.73; P=.001; I²=0.0%). Radiofrequency ablation and bipolar cord coagulation had comparable survival rates (odds ratio, 0.85; 95% confidence interval, 0.54–1.35; P=.49; I²=0.0%). In 3 studies that compared radiofrequency ablation with interstitial laser, there was no significant difference in gestational age at delivery (P=.07) or survival (P=.15). In 3 studies that compared bipolar cord coagulation with interstitial laser, bipolar cord coagulation was associated with a higher survival rate (odds ratio, 3.21; 95% confidence interval, 1.13–9.10; P=.03; I²=0.0%), but the gestational age at delivery was comparable between groups (P=.16).

Conclusion

This study demonstrated that radiofrequency ablation has a greater procedure to delivery interval and decreased preterm premature rupture of membranes and preterm birth than bipolar cord coagulation. Although there was no difference in gestational age at delivery for either bipolar cord coagulation, radiofrequency ablation, or interstitial laser, survival was higher with bipolar cord coagulation than with interstitial laser.

中文翻译：

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选择性减少复杂单绒毛膜妊娠：不同技术的系统评价和荟萃分析

客观的

这项系统评价和荟萃分析旨在比较复杂单绒毛膜妊娠在通过射频消融、双极脐带电凝和间质激光选择性复位后的围产期结局。

数据源

从数据库创建到 2021 年 4 月 26 日，我们检索了 PubMed、Scopus 和 Web of Science。

学习资格标准

在复杂的单绒毛膜妊娠中比较至少 2 种选择性减少技术并提供围产期结局数据的研究，包括手术胎龄、分娩胎龄、手术至分娩间隔、早产胎膜早破、早产、存活率和出生体重，有资格。

方法

随机效应模型用于汇总平均差异或优势比和相应的 95% 置信区间。使用I ²值评估异质性。

结果

共有10项研究734例减胎符合纳入标准，其中9项研究674例符合定量综合条件。在 8 项比较射频消融与双极脐带电凝的研究中，射频消融与增加手术至分娩间隔（天）相关（平均差，13.42；95% 置信区间，1.90-24.94；P =.02；I ² =0.0% )，减少早产（优势比，0.50；95% 置信区间，0.29–0.85；P =.01；I ² =3.0%），减少早产胎膜早破（优势比，0.45；95% 置信区间， 0.27–0.73；P =.001；I ²=0.0%）。射频消融和双极脐带电凝的存活率相当（优势比，0.85；95% 置信区间，0.54-1.35；P =.49；I ² =0.0%）。在 3 项比较射频消融与间质激光的研究中，分娩时的胎龄 ( P =.07) 或存活率 ( P =.15) 没有显着差异。在 3 项比较双极脐带电凝与间质激光的研究中，双极脐带凝与较高的存活率相关（优势比，3.21；95% 置信区间，1.13-9.10；P =.03；I ² =0.0%），但分娩时的胎龄在各组之间具有可比性（P =.16）。

结论

该研究表明，射频消融比双极脐带电凝具有更大的分娩间隔和减少早产胎膜早破和早产。尽管双极脐带电凝、射频消融或间质激光在分娩时的胎龄没有差异，但双极脐带电凝的存活率高于间质激光。