Ongoing Triplet Research Articles

Outcomes of fetal reduction versus expectant management in dichorionic triamniotic triplets.

To compare the outcomes of dichorionic triamniotic (DCTA) triplets who underwent fetal reduction (FR) to singletons or twins with those managed expectantly. We conducted a retrospective study of DCTA triplets with three living fetuses at 11-14weeks over a 7-year period. Pregnancy outcomes were compared following different management strategies. Of 108 included patients, 22 underwent expectant management (EM), 28 were reduced to dichorionic diamniotic twins, and 58 to singletons. The median gestational age at birth for EM, FR to twins, and singletons was 33.1weeks, 37.0weeks, and 38.6weeks, respectively (P<0.001). Prematurity before 37 and 34weeks was less common following FR to singletons and twins than in ongoing triplets (18.9%, 46.2% and 90.5%, P<0.001; 13.2%, 26.9% and 57.1%, P<0.001). Neonatal birth weight was higher in triplets reduced to singletons and twins compared with EM cases (3140g, 2315g, and 1860g, P<0.001). However, rates of miscarriage, pregnancies with ≥1 survivor, maternal complications, and adverse neonatal outcomes were comparable among the three groups. In our experience, FR in DCTA triplets could reduce prematurity risk compared to EM, but it confers no survival advantage. Fetal reduction to singletons may result in more favorable outcomes than those reduced to dichorionic twins.

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

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.

Multifetal Pregnancy Reduction of Trichorionic Triplet Gestations: What is the Benefit?

Objective This study aims to determine the efficacy of multifetal pregnancy reduction (MFPR) in improving obstetrical outcomes for trichorionic triplet gestations. Study Design Retrospective cohort study of patients with multiple gestations delivered by a single maternal-fetal medicine practice from 2005 to 2016. We compared patients with trichorionic triamniotic triplet gestations who underwent MFPR to those with an ongoing triplet pregnancy (TT), as well as primary dichorionic diamniotic twin gestations (DD). Logistic regression analysis was used to control for any differences at baseline. Results There were 42 patients in the MFPR group, 43 women in the TT group, and 693 women in the DD group. Comparing MFPR to TT, the likelihood of preterm birth &lt; 34 weeks was similar (31.0 vs. 39.5%, adjusted odds ratio [aOR]: 0.63, 95% confidence interval [CI]: 0.21, 1.87). There were no differences in gestational age at delivery, pregnancy loss &lt; 24 weeks, or the likelihood of all, none, or at least two babies surviving to discharge. Mean birth weights were significantly higher and cesarean delivery rates lower for MFPR (2,128 vs. 1,836 g, p = 0.028 and 69 vs. 86%, aOR: 0.25, 95% CI: 0.06, 0.94) as compared with the TT group. MFPR had significantly worse outcomes than DD. Conclusion In trichorionic triamniotic triplet pregnancies, our study suggests that obstetrical outcomes may not be as dramatically improved with MFPR as seen in older studies.

The influence of multifetal pregnancy embrioreduction in high-risk pregnancies: Clinical management and outcome

Introduction: To decrease the risks associated with triplets pregnancies MFPR is preformed. The most frequently applied method is through ultrasound guided transabdominal injection of potassium chloride into the fetal heart or chest cavity at 11-14 weeks of gestation. Aim: The main objective of this study was to evaluate perinatal outcomes in triplet pregnancies after transabdominal MFPR as compared with ongoing triplet pregnancies and twin pregnancies. Material and methods: In this retrospective study, all women with trichorionic triplet pregnancies undergoing MFPR to a twin pregnancy, women with an ongoing trichorionic triplet pregnancy and with those with a primary dichorionic twin pregnancy were included. Results: Median gestation age at delivery was 35.6 ( interquartile range [IQR], 32.8-37 weeks) for triplets reduced to twins, 32.8 weeks (IQR, 27.6-34.7 weeks) for ongoing triplets, and 37 weeks ( IQR, 35.1-38.3 weeks) for primary twins (p <0.01 difference between all groups). There were 7 women in the reduction group (12.28%) vs 10 (19.6%) in the ongoing triplet group, whi and 4 (6.66%) in the primary twin group in whom not a single fetus survived. Preterm delivery before 32 weeks of gestation occurred less in the reduction group compared with the ongoing triplets (12 [20.9%] vs 18 [35.29%] ), but still more often than in primary twins - 7 (11.66%). Conclusion: Multifetal pregnancy reduction (MFPR) seems to be associated with a decreased risk of pregnancy loss both before 24 and 32 weeks of gestation in women with trichorionic triplet reduction.

Outcome of Multifetal Pregnancy Reduction in Women with a Dichorionic Triamniotic Triplet Pregnancy to a Singleton Pregnancy: A Retrospective Nationwide Cohort Study

Objective: To study the pregnancy outcomes of women with a dichorionic triamniotic triplet pregnancy that was reduced to a singleton pregnancy and to review the literature. Methods: We performed a nationwide retrospective cohort study. We compared time to delivery and perinatal mortality in dichorionic triplet pregnancies reduced to singletons with ongoing dichorionic triplet pregnancies and primary singleton pregnancies. Additionally, we reviewed the literature on the subject. Results: We studied 46 women with a reduced dichorionic triplet pregnancy and 42 women with an ongoing dichorionic triplet pregnancy. Median gestational age at delivery was 38.7 vs. 32.8 weeks, respectively (p < 0.001). Delivery <24 weeks occurred in 9 (19.6%) women with a reduced triplet pregnancy and 4 (9.5%) with an ongoing triplet pregnancy (p = 0.19). Perinatal survival rates between the reduced group and the ongoing triplet group were not significantly different. Conclusion: Multifetal pregnancy reduction in women with a dichorionic triplet pregnancy to a singleton pregnancy prolongs median gestational age at birth. No statistically significant association was found with miscarriage and perinatal survival rates.

The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation

The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P < .001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins. In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.

A comparative study of obstetric outcomes in electively or spontaneously reduced triplet pregnancies

This study aimed at evaluating the pregnancy outcomes of IVF triplets which are spontaneously or electively reduced to twins and to compare them with non-reduced triplets and twins. Retrospective analysis of trichorionic triplets and dichorionic twins of IVF pregnancies. Preeclampsia rate was significantly higher in triplet group (p = 0.014). Premature contractions requiring tocolysis were seen more often in spontaneous reduction and triplet groups compared to elective reduction and twin groups (p < 0.001). Elective reduction and twin groups had significantly lower rate of infants weighing less than 1,500 g than those of triplets (p < 0.001). Highest rate for infants weighing over 2,500 g was found in primary twin group. Preterm delivery rates were significantly lower in both twin and elective reduction groups compared to triplet and spontaneous reduction groups (p < 0.001). Proportion of women giving birth at term was not different in elective reduction and twin groups, and they were significantly higher compared to spontaneous reduction group (p = 0.024). Perinatal mortality rates of both elective reduction and twin groups were significantly less than those in the triplet group (p = 0.045 and p < 0.001, respectively). Obstetric outcomes of triplets from IVF or ovulation induction cycles undergoing elective reduction are better than ongoing triplet and spontaneous reduction groups and are similar to that of dichorionic twins.

OP30.02: Comparison of pregnancy outcomes among ongoing triplet pregnancies, triplet pregnancies reduced to twins, and primary twin pregnancies in a single tertiary center

OP30.02: Comparison of pregnancy outcomes among ongoing triplet pregnancies, triplet pregnancies reduced to twins, and primary twin pregnancies in a single tertiary center

27: Outcome after embryo reduction in triplet pregnancy compared to ongoing triplet pregnancies and primary twins

27: Outcome after embryo reduction in triplet pregnancy compared to ongoing triplet pregnancies and primary twins

Obstetric outcomes of IVF trichorionic triamniotic triplets which are spontaneously or electively reduced to twins

To assess the obstetric outcome of IVF triplets which are spontaneously or electively reduced to twins. Retrospective study of trichorionic triplets (TT) and dichorionic twins (DT) conceived with IVF. Compared to TT without reduction, TT with spontaneous reduction (SR) (OR: 5.6, 95% CI: 1.6-19.9) or elective reduction (ER) (OR: 14.0, 95% CI: 3.92-50.02) to twins were significantly more likely to be delivered at ≥34 weeks. Compared to DT likelihood of delivery ≥34 weeks was similar for SR and ER. Compared to TT without reduction, the risk of pregnancy loss before 24 weeks was not increased with SR or ER. Compared to DT the risk of pregnancy loss before 24 weeks was not significantly increased for SR or ER. Obstetric outcome of IVF triplets with SR is better than ongoing triplets and is similar to that of ER of TT and DT.

Spontaneous reduction before 12 weeks' gestation and selective reduction similarly extend time to delivery in in vitro fertilization of trichorionic-triamniotic triplets

To determine the prevalence and the relative benefits conferred by selective and spontaneous reduction of one or more fetuses in trichorionic triamniotic triplet pregnancies on time to delivery. Retrospective cohort study. Academic medical center. IVF patients with trichorionic triamniotic triplets between January 1998 and December 2007. None. Gestational length at time of delivery. Selective reduction to twins was used in 87 of the 153 (56.9%) triplet pregnancies that did not spontaneously reduce prior to <12 weeks, and was associated with longer gestation (13.9 days) with a fourfold greater likelihood of delivery at ≥ 34 weeks' gestation (odds ratio [OR], 4.3; 95% confidence interval [CI] = 2.2-8.6), compared with pregnancies not undergoing selective reduction. Compared with ongoing triplets, spontaneous reduction at <12 weeks' gestation (28 cases) was associated with longer gestation (13.7 days) and significantly greater likelihood delivering at or after 34 weeks' gestation (OR, 3.7; 95% CI, 1.4-9.9). Selective reduction of one fetus was used in 56.9% of patients in this population. Early spontaneous reduction (<12 weeks) and selective reduction to twins each conferred similar benefits by extending time to delivery and increasing the likelihood of delivery at or after 34 weeks' gestation.

Monozygotic multiple gestation after intracytoplasmic sperm injection and preimplantation genetic diagnosis

To report a possible association between intracytoplasmic sperm injection (ICSI)-preimplantation genetic diagnosis (PGD) and monozygotic multiple gestation. Small case series. In vitro fertilization unit in an academic medical center. Three patients were treated with ICSI-PGD for sexing as well as selection against a known translocation. Transfer of day 4 embryos to the uterus. Clinical pregnancy. Two pairs of monozygotic twins and a triplet pregnancy. Repeated manipulation of the zona pellucida as well as extended embryo culture during ICSI-PGD treatments may result in monozygotic twin and triplet pregnancies.

Monozygotic triplet pregnancy following egg donation and transfer of single frozen-thawed embryo

To describe a case of monozygotic triplet pregnancy following egg donation and the transfer of a single frozen-thawed embryo. Case report. District general hospital and regional department of fetal medicine in northeast England. A 38-year-old woman with a 2-year history of primary infertility due to severe endometriosis and poor ovarian reserve who conceived after egg donation and transfer of a single frozen-thawed embryo. Transfer of a single frozen-thawed embryo and delivery of three identical female infants by emergency caesarean section because of preterm labor at 32 weeks' gestation. Review of effect of assisted conception on monozygotic twinning rates. Healthy outcome for all three infants. Assisted reproductive treatments may lead to disturbances in zona pellucida architecture and an increase in monozygotic twinning rates. Couples need to be informed of this and the increased risks associated with these pregnancies before they begin with treatment.

Outcome of triplet pregnancies after assisted reproductive techniques: How frequent are the vanishing embryos?

To assess the incidence of spontaneous embryo reduction as well as the obstetric and neonatal outcome of triplet gestations after assisted reproductive techniques (ART). We analyzed the spontaneous outcome of 38 pregnancies in which three gestational sacs were identified with vaginal ultrasound between 21 and 28 days after ART. Weekly follow-up visits were scheduled during the first trimester until referral to a high-risk obstetrician. After delivery, each patient was interviewed individually and, if necessary, the obstetrician was contacted. The triplets delivery rate was 47.4%, whereas 31.6% delivered twins, 18.4% delivered singletons, and only one patient miscarried all three cases (2.6%). Finding three fetal heart beats was associated with a triplet delivery rate of 69.2%, a twin incidence of 19.2%, and a singleton birth rate of 11.6%. Embryo resorptions were observed mainly during the first 7 weeks of gestation and did not occur beyond the 14th week. The mean gestational age at delivery and neonatal birth weight were significantly lower among triplets (32.8 weeks and 1,740 g versus 35.3 weeks and 2,352 g in twins and 39.1 weeks and 3,122 g for singletons). Triplets had a 100% prematurity and cesarean section rate compared with 67% and 75% in twins and 0% and 43% in singletons, respectively. Hospitalization at the Neonatal Intensive Care Unit was required in 83% of newborn triplets, 29% of twins, and 0% of singletons, with a mean stay of 34 and 21 days for triplets and twins, respectively. One stillbirth and no neonatal deaths were reported, with an overall perinatal mortality rate of 11.9 per 1,000. Spontaneously, approximately 50% of triplet pregnancies will experience at least one embryo resorption. The ongoing triplets demand a complex and more expensive perinatal management, a strong argument to consider limiting the number of oocytes-embryos transferred in ART.