| ObjectiveTo compare the pregnancy outcomes of women with dichorionic triamniotic(DCTA)triplet pregnancies after fetal reduction with radiofrequency ablation(RFA)or potassium chloride(KCL),and offer better guide for them.MethodsThis was a retrospective cohort study.In this study,all DCTA triplets who chose RFA or KCL method to reduce their fetuses in Obstetrics of Central District of Shandong Provincial Hospital from January,2011 to January,2018 were selected.In KCL group,89 women were included,4 of whom were out of touch and thus were excluded from this study.As a result,85 women were suitable for the study.A total of 30 women were identified in RFA group,all of their pregnancy outcomes were successfully tracked,so all of them were suitable for the study.We compared the mean neonatal birthweight,median gestational age and perinatal mortality of DCTA triplets between two groups.ResultsFirst of all,there was no statistically significant difference between the two groups in gestational age and pregnancy mode.And in our study,the median gestational age for women in RFA group was 37.1 weeks(interquartile range[IQR],35.9-37.8 weeks),while in KCL group was 38.0 weeks([IQR],36.1-39.0 weeks,P>0.05).We can see that that the median gestational age of RFA group was smaller than that of KCL group,but there was no statistically significant difference between the two groups.The mean neonatal birthweight of children in RFA group was 2572.4g[standard deviation(SD),407.0],and 2899.3g(SD,554.9)in KCL group(P<0.001).It was obvious that the neonatal birthweight of RFA group was smaller than that of KCL group,but there was no statistically significant difference between the two groups.The number of low birth weight infants of RFA group was 23(42.6%),while that of KCL group was 16(18.0%)(RR,3.39[95%CI 1.58-7.27]).None of children in RFA group was very low birth weight infant,and that of KCL was 2(2.2%),but there was no statistically significant difference between the two groups.Among the RFA group,2(6.7%)women had only one fetus survived,vs 63(71.4%)in the KCL group(RR 0.09(95%CI 0.02-0.35)).And 26(86.7%)in the RFA group had two fetuses survived,compared 13(15.3%)in the KCL group(RR36.00[95%CI 10.77-120.37]).There were a total of 28(93.3%)women in the RFA group got pregnancy success(We define the successful pregnancy as the condition that at least one child survives for a specific woman,while the failed one as no child survives.),vs 76(89.4%)in the KCL group(RR1.66(95%CI 0.34-8.15)).And the number of cases ended in pregnancy failure in RFA group was 2(6.7%),vs 9(10.6%)in KCL group(RR 0.63(95%CI 0.12-2.97))ConclusionWhat we took it for granted was that pregnancy outcomes in women with a reduced DCTA triplet managed with RFA was riskier than with KCL,however,we proved that it is not accurate.For women with a reduced DCTA triplet,managed with RFA is not much riskier than with KCL.What's more,most women have two surviving fetuses in RFA group,while in KCL group,only one fetus survives for most women This result may change the management alternative for those women with DCTA triplet pregnancies who choose reduction,especially for women who desire to have two surviving and healthy fetuses. |
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