Abstract
BackgroundTrichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. However, data on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are lacking. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11–13+ 6 gestational weeks.MethodsTwo hundred ninety-eight patients with DCTA triplets conceived via IVF-ET between 2012 and 2016 were retrospectively analysed. DCTA triplets with three live foetuses were reduced to a MC singleton (group A) or MCDA twins (group B) or underwent expectant management (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11–13+ 6 gestational weeks. Pregnancy outcomes in the 3 groups were compared.ResultsEighty-four DCTA pregnancies were reduced to MC singleton pregnancies, 149 were reduced to MCDA pregnancies, and 65 were managed expectantly.There were no significant differences among groups A, B, and C in miscarriage rate (8.3 vs. 7.4 vs. 10.8%, respectively) and live birth rate (90.5 vs. 85.2 vs. 83.1%, respectively) (P > 0.05).Group A had significantly lower rates of preterm birth (8.3 vs. 84.6%; odds ratio (OR) 0.017, 95% confidence interval (CI) 0.006–0.046) and low birth weight (LBW; 9.2 vs. 93.2%; OR 0.007, 95% CI 0.003–0.020) than group C (P < 0.001).Group B had significantly lower preterm birth (47.0 vs. 84.6%; OR 0.161, 95% CI 0.076–0.340) and LBW rates (58.7 vs. 93.2%; OR 0.103, 95% CI 0.053–0.200) than group C (P < 0.001).Group A had significantly lower preterm birth (8.3 vs. 47.0%; OR 0.103, 95% CI 0.044–0.237; P < 0.001), LBW (9.2 vs. 58.7%; OR 0.071, 95% CI 0.032–0.162; P < 0.001) and perinatal death rates (1.3 vs. 9.1%; OR 0.132, 95% CI 0.018–0.991; P = 0.021) than group B.ConclusionThe MFPR of DCTA triplets to singleton or MCDA pregnancies was associated with better pregnancy outcomes compared to expectant management. DCTA triplets reduced to singleton pregnancies had better perinatal outcomes than DCTA triplets reduced to MCDA pregnancies.
Highlights
Trichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage
We found that the multifoetal pregnancy reduction (MFPR) of dichorionic triamniotic (DCTA) pregnancies to either MC singleton or monochorionic diamniotic (MCDA) twin pregnancies improved the pregnancy and obstetric outcomes by significantly decreasing the risks of preterm birth, very preterm birth (VPB) and low birth weight (LBW) and significantly increasing the gestational age (GA) at delivery and live birth weight, with no significant reduction in the miscarriage risk
Group A = DCTA pregnancy reduced to MC singleton pregnancy; Group B = DCTA pregnancy reduced to MCDA twin pregnancy DCTA dichorionic triamniotic, MC monochorionic, MCDA monochorionic diamniotic, OR odds ratio, CI confidence interval, IUD intrauterine death, Neonatal death (NND) neonatal death, VPB very preterm birth, LBW low birth weight, VLBW very low birth weight
Summary
Trichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not with a lower risk of miscarriage. This study aimed to compare the pregnancy outcomes of DCTA triplets conceived via in vitro fertilization-embryo transfer (IVF-ET) managed expectantly or reduced to a monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twins at 11–13+ 6 gestational weeks. To reduce the risks associated with triplet pregnancies and HOMPs [18, 19], multifoetal pregnancy reduction (MFPR) has been performed in recent years, and several methods have been described [20, 21]. There is ample evidence that reducing quadruplet-or-higher pregnancies to twins is associated with more favourable outcomes, including advanced gestational age (GA) at delivery [15, 16, 22]. A meta-analysis [23] showed that trichorionic triplet pregnancy reduction to a twin pregnancy is associated with a lower risk of preterm delivery with no significant increase in the miscarriage rate. Data on the perinatal outcomes of women with dichorionic triamniotic (DCTA) triplet pregnancies who undergo MFPR are lacking, and two metaanalyses on this subject reported that the numbers are insufficient to recommend one technique over another or to draw clear conclusions on the perinatal outcomes of DCTA pregnancies [3, 23]
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