Fetal reduction from twin to singleton gestation: A meta-analysis.
Ron Bardin1,2, Mamta Gupta3, Gal Greenberg1,2
1Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.
Summary
Fetal reduction from twin to singleton pregnancy significantly lowers the risk of preterm birth, hypertensive disorders, and cesarean delivery. Further research is recommended to confirm these benefits for maternal and infant outcomes.
Area of Science:
- Maternal-Fetal Medicine
- Reproductive Health
- Obstetrics
Background:
- Twin pregnancies carry higher risks for adverse maternal and neonatal outcomes compared to singleton pregnancies.
- Selective fetal reduction is a procedure to reduce the number of fetuses in a multiple gestation.
Purpose of the Study:
- To evaluate the outcomes of fetal reduction in twin pregnancies.
- To compare maternal and neonatal outcomes between twin gestations undergoing fetal reduction and those continuing as twins.
Main Methods:
- A systematic literature search was conducted across PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar (1980-2020).
- Included studies were prospective or retrospective analyses of pregnant women with twin gestations undergoing transabdominal reduction to singleton pregnancy, with a comparison group of ongoing twin gestations.
- Outcomes were meta-analyzed if reported in at least three studies.
Main Results:
- Six studies involving 2867 women were analyzed; 624 underwent fetal reduction (2-to-1), and 2243 did not.
- Fetal reduction was associated with significantly lower odds of preterm birth before 34 weeks (OR 0.64) and 37 weeks (OR 0.23).
- The odds of hypertensive disorders (OR 0.25) and cesarean delivery (OR 0.35) were also significantly reduced in the fetal reduction group.
Conclusions:
- Selective fetal reduction in twin pregnancies decreases the likelihood of preterm birth, hypertensive disorders, and cesarean delivery.
- The findings suggest potential benefits of fetal reduction for improving pregnancy outcomes.
- Further adequately powered prospective studies are necessary to substantiate these results.
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