Outcome of monochorionic triamniotic triplet pregnancies: Expectant management versus fetal reduction.

Abstract

To compare the outcomes of monochorionic triamniotic (MCTA) triplets managed expectantly with those reduced to twins. This was a retrospective cohort study comparing expectant management (EM) with fetal reduction (FR) to twins in 43 consecutive MCTA triplets with 3 live fetuses at 11-14weeks between 2012 and 2021. Nineteen patients managed expectantly and 24 triplets reduced to twins were included. The rate of pregnancy with at least one survivor was 84.2% in the EM group and 66.7% in the FR group (P=0.190). Compared to the EM cases, triplets reduced to twins had a higher median gestational age at delivery (36.0 vs. 33.3weeks; P<0.001), a higher mean birth weight (2244.3±488.6g vs. 1751.1±383.2g; P<0.001) and a lower risk of preterm birth before 34weeks (11.8% vs. 64.7%; P=0.001). There were no significant differences in the risk of miscarriage, pregnancy complications and composite adverse neonatal outcomes. In MCTA triplets, FR to twins could reduce the risk of preterm birth, whereas EM seems to be a reasonable choice when the priority is at least one survivor. However, due to the small sample size of this study, these findings must be interpreted with great caution.