Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies

 

Abstract

Background

When couples are faced with the dilemma of a higher order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses.

Objectives

To assess a policy of multifetal reduction with a policy of expectant management of women with a triplet or higher order multiple pregnancy.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 September 2009).

Selection criteria

Randomized controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a triplet or higher order multiple pregnancy.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data.

Main results

There were no randomised controlled trials identified.

Authors' conclusions

There are insufficient data available to support a policy of pregnancy reduction procedures for women with a triplet or higher order multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures, reduction in the number of fetuses by selective termination may not been acceptable to women, especially for those with a past history of infertility. The acceptability of this option, and willingness to undergo randomisation will depend on the couple's social background and beliefs, and consequently, recruitment to such a trial may prove exceptionally difficult.

 

Plain language summary

Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies

No strong evidence about the effects of reducing the number of fetuses in women pregnant with triplets or higher order multiples (three or more fetuses).

When a woman carries three or more babies in pregnancy, there may be difficult decisions to face. These babies are less likely to survive, and if they do, their health may suffer. It is possible to reduce the number of babies that the mother carries in the hope of improving the health of the remaining babies. There were no good studies to help parents make this difficult choice.

 

摘要

背景

針對懷有3胞胎以及更多胎數之婦女，減少胎兒的數目

當夫妻們面臨懷有多胞胎而陷入進退兩難時，可以有3種選擇。(1)終止整個懷孕過程，但通常不會被婦女們接受，尤其是對於那些過去曾有過不孕症病史的婦女。(2)若是試圖要維持所有的胎兒，就會遇到一些問題，像是早產、存活率，以及長期的罹病狀況等等。(3)藉由選擇性終止的方式來減少胎兒的數目。對於夫妻來說，關於這些選項的接受程度，將會視他們的社會背景與潛在的優點而定。本篇回顧的重點在於減少胎兒的數目

目標

懷有3胞胎或是更多胎數之孕婦，要評估減胎政策，與預期性處理政策之比較

搜尋策略

我們搜尋了Cochrane Pregnancy and Childbirth Group's Trials Register (2009年9月25日)

選擇標準

針對懷有3胞胎或是更多胞之孕婦，比較預期性處理與選擇性減胎，評估之母親與嬰兒的預後，收集有這些報告資料的隨機試驗

資料收集與分析

有2位審稿者獨立地評估了試驗的品質，並擷取出資料

主要結論

並沒有任何隨機的對照試驗經過認證

作者結論

針對懷有3胞胎或是更多胞胎的孕婦，並沒有足夠的可利用資料可以用來支持減胎的政策。當減胎的風險與優點可由隨機對照試驗來提供最可信賴的證據時，藉由選擇性終止的方式來進行的胎兒數目縮減，可能就不會被一些婦女們所接受，尤其是對於那些曾經有過不孕症病史的婦女。對於這個選項的接受程度，以及選擇進行隨機的意願，都必須要視夫妻的社會背景與相關的優點而定，因此，要在這樣的一種試驗中募集到人選，可能會變得異常地困難

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

針對在懷有3胞胎或是更多胞胎(3個或是更多的胎兒)的婦女身上，關於減少胎兒的數目所帶來的影響，並沒有強烈的證據可以證實。當1名婦女在懷孕期間懷有3個或更多的嬰兒時，可能會要面臨艱難的決定。這些嬰兒不太可能都存活下來，而且如果存活下來的話，他們的健康狀況也是可能有問題的。若是希望能夠提升存活下來之嬰兒的健康程度，較可能的方法是減少母親肚子裡所懷的胎兒數目。要作出這樣艱難的決定，目前還沒有良好的研究可以幫助這些父母們