Effect Of Different Methods Of Fetal Reduction On The Outcome Of Multiple Pregnancies With Assisted Reproductive Technology

ObjectiveThis article compares the rate of miscarriage,the gestational week of delivery and the birth weight of the newborn after the early transvaginal reduction surgery and the mid-term transabdominal reduction in patients with multiple pregnancy,to explore the effect of different reduction methods on multiple pregnancy with assisted reproduction.MethodRetrospectively analyzed 61 patients with multiple pregnancies who underwent fetal reduction in the Reproductive Department of the First Affiliated Hospital of Hainan Medical University from January 2015 to January 2020.According to the gestational age at the time of fetal reduction,These patiens were divided into the early(6-10 weeks gestation)transvaginal fetal reduction group(n=28),and the mid-term(12-28 weeks gestation)transabdominal fetal reduction group(n=33).According to the number of remaining embryos after reduction,the two groups were futher divided into singleton-preserving group and twins--preserving group.Among them,the transvaginal singleton-preserving group(n=13)and the transvaginal twins-preserving subgroup(n=15);transabdominal singleton-preserving group(n=24)and twins-preserving group(n=9).(1)Compared the the rate of miscarriage,gestational week of delivery and birth weight of the newborns in the two groups;(2)According to the inclusion and exclusion criteria,the singleton pregnancy(n=31)who received assisted reproductive assistance during the same period were randomly added to compared the rate of miscarriage,the gestational week of delivery and the birth weight of the newborn with the singleton-preserving group after the two fetal reduction methods.(3)According to the inclusion and exclusion criteria,the twins pregnancy(n=29)who received assisted reproductive assistance during the same period were randomly added to compared the rate of miscarriage,the gestational week of delivery and the birth weight of the newborn with the twins-preserving group after the two fetal reduction methods.(4)Log-rank test was performed by Kaplan-Meier survival curve to analyze the number of fetal reductions and the influence of two fetal reduction methods on the gestational week of delivery.Result1.Comparison of pregnancy outcomes in the transvaginal reduction groupsCompared with the transvaginal twins-preserving group,the transvaginal singleton-preserving group had higher the rate of miscarriage(0%vs 23.0%),but the difference between the groups was not statistically significant(P>0.05),but the gestational week of delivery(36.23±2.74)vs 38.82±1.17)longer,the birth weight of the newborn(2.40±0.46 vs 3.08±0.3 3)increased,and the differences between groups were statistically significant(P<0.05).2.Comparison of pregnancy outcomes in the transabdominal reduction groupCompared with the transabdominal twins-preserving group,the transabdominal singleton-preserving group had lower the rate of miscarriage(22.2%vs 4.2%),longer gestational week of delivery(35.22±1.92 vs 36.76±2.86),and heavier the birth weight of the newborn(2.37±0.52 vs.2.68±0.48),but the difference s were not statistically significant(P>0.05).3.Comparison of pregnancy outcomes between the reduced fetus group and the control group with singleton groupThe rate of miscarriage was not statistically significant(P>0.05)between the three groups of the transvaginal singleton-preserving group,the transabdominal singleton-preserving group,and the control group(23.0%vs 4.2%vs 16.1%).Compared with the control group,there were no statistically significant difference in the gestational week of delivery(38.59±1.58 vs 38.82±1.17)and the birth weight of the newborn(3.24±0.44 vs 3.08±0.33)of the transvaginal singleton-preserving group(P>0.05).Compared with the control group,the gestational age of the transabdominal singleton-preserving group was significantly shortened(38.59±1.58 vs 36.76±2.86)(P<0.05),and the birth weight of the newborn was significantly reduced(3.24±0.44 vs 2.68±0.48)(P<0.05).Compared with the transvaginal singleton-preserving group,the transabdominal singleton-preserving group significantly shortened the gestational week of delivery(38.82±1.17 vs 36.76±2.86)(P<0.05),and the birth weight of the newborn was significantly reduced(3.08±0.33 vs 2.68±0.48))(P<0.05).4.Comparison of pregnancy outcomes between the reduced pregnancy group and the control group with twins-preserving groupThe rate of spontaneous fetal reduction rate(6.7%vs 22.2%vs 6.8%),the rate of miscarriage(0%vs 22.2%vs 24%),gestational week of delivery(36.23±2.74 vs 35.22±1.92 vs 36.48±2.68)and the birth weight of the newborn(2.40±0.46 vs 2.37±0.52 vs 2.55±0.56)There were no significant difference between the three groups of transvaginal twins-preserving,transabdominal twins-preserving and the control group P>0.05).5.The relationship between the number of lost fetuses and the gestational week of deliveryThe gestational weeks of delivery of patients with different numbers of fetuses were further compared,and Log-rank test was performed in parallel.There was no statistically significant difference in the gestational age of the newborns(P>0.05).6.The relationship between fetal reduction methods and gestational age at deliveryThe gestational weeks of delivery of patients with two different fetal reduction methods were further compared,and Log-rank test was performed in parallel.There was no statistically significant difference in the gestational age of the newborns(P>0.05).Conclusion1.In the singleton-preserving,early transvaginal fetal reduction is more conducive to increase gestational week of delivery and the birth weight of the newborn than midterm transabdominal fetal reduction;while in twins-preserving,transvaginal fetal reduction and transabdominal fetal reduction do not affect the rate of miscarriage,the rate of spontaneous fetal reduction rate,gestational week of delivery,and the birth weight of the newborn.2.After transvaginal fetal reduction,the outcome of gestational week and newborn birth weight of singleton is better than that of twins.After the transabdominal fetal reduction,the outcome of pregnancy is not affected by the number of fetuses being reduced and retained.3.Fetal reduction surgery is an effective remedy to improve the outcome of multiple pregnancies.However,in view of the risks of natural fetal reduction and abnormal fetal development during the embryonic development of twins,it can be considered after the fetus has been tested for NT and chorionicity then to perform fetal reduction surgery.