143. Recovery of second trimester preeclampsia in triplet after foetal reduction; a case history and review of the literature

Abstract

Introduction Women with a multiple pregnancy are at increased risk of developing hypertensive disorders of pregnancy. Electively reduction in a triplet pregnancy have lower prevalence of preeclampsia compared to ongoing triplets or spontaneously reduced triplets. Objective/hypothesis Selective feticide might suggested as an option in early onset preeclampsia in dichorionic multiple pregnancies as alternative for termination the whole pregnancy. Methods We described a case of a dichorionic triamniotic triplet complicated by severe preeclampsia at 16 weeks gestational age. Additionally, we performed a review of the literature on selective feticide in multiple pregnancies on maternal indication in PubMed, MEDINE and EMBASE. Results In our case, after reduction of the monochorionic twin, symptoms of preeclampsia clinically resolved, and delivery was postponed for more than 17 weeks at 32 weeks of gestation. In an additional review of the literature, we described 6 papers including 8 cases on multifetal pregnancy reduction on maternal indication. Reduction of multifetal pregnancy resulted in 2 to 21 week extension of time to delivery in women with preeclampsia. Discussion Selective feticide might be suggested as an (exceptional) alternative in early onset preeclampsia in dichorionic multiple pregnancies. Unequivocal counselling is essential because of the increased risk of adverse pregnancy outcome by extension of complicated pregnancy.