Trichorionic Triplet Pregnancies Research Articles

Birth outcomes of twins after multifetal pregnancy reduction compared with primary twins

BackgroundThe introduction of assisted reproductive technology and the trend of increasing maternal age at conception have been responsible for a significant rise in the incidence of multiple pregnancies. Multiple pregnancies bear several inherent risks for both mother and child. These risks increase with plurality and type of chorionicity. Multifetal pregnancy reduction is the selective abortion of one or more fetuses to improve the outcome of the remaining fetus(es) by decreasing the risk of premature birth and other complications. ObjectiveThis study compares the birth outcomes of trichorionic triplets reduced to twins with trichorionic triplets and primary dichorionic twins. The added value of this study is the comparison with an additional control group, namely primary dichorionic twins. Study designThis is a retrospective cohort study. Data from January 1990 till November 2016 were collected from the East Flanders Prospective Twin Survey, one of the largest European multiple birth registries. Eigthy-five trichorionic triplet pregnancies (170 neonates) undergoing multifetal pregnancy reduction (MPR) to twins were compared to 5,093 primary dichorionic twin pregnancies (10,186 neonates) and 104 expectantly managed trichorionic triplet pregnancies (309 neonates). The outcomes are gestational age at delivery, birth weight, and small for gestational age. ResultsPregnancy reduction from triplets to twins is associated with a higher birth weight (+365.44 g, 95%CI [222.75, 508.14 g], p < .0001) and longer gestational age (1.7 weeks, 95%CI [0.93, 2.46], p< .0001) compared to ongoing trichorionic triplets, adjusted for sex, parity, method of conception, birth year, and maternal age. A trend towards a lower risk of SGA is observed. Reduced triplets have, on average, a lower birth weight (-263.12 g, 95%CI [-371.80, -154.44 g], p < .0001), and a shorter gestational age (-1.13 weeks, 95%CI [-1.70, -0.56], p=0.0001) compared to primary twins. No statistically significant difference between primary twins and reduced triplets that reach 32 weeks of gestation is observed. ConclusionMultifetal pregnancy reduction from trichorionic triplets to twins significantly improves birth outcomes. This suggests that MPR of trichorionic triplets to twins is medically justifiable. However, the birth outcomes of primary twins before 32 weeks of gestation are still better in comparison with reduced triplets. The process of MPR includes at least one fetal death by definition, therefore prevention of higher-order pregnancies is preferred.

Triple trouble: uncovering the risks and benefits of early fetal reduction in trichorionic triplets in a large national Danish cohort study

Triplet pregnancies are high risk for both the mother and the infants. The risks for infants include premature birth, low birthweight, and neonatal complications. Therefore, the management of triplet pregnancies involves close monitoring and may include interventions, such as fetal reduction, to prolong the pregnancy and improve outcomes. However, the evidence of benefits and risks associated with fetal reduction is inconsistent. This study aimed to compare the outcomes of trichorionic triplet pregnancies with and without fetal reduction and with nonreduced dichorionic twin pregnancies and primary singleton pregnancies. All trichorionic triplet pregnancies in Denmark, including those with fetal reduction, were identified between 2008 and 2018. In Denmark, all couples expecting triplets are informed about and offered fetal reduction. Pregnancies with viable fetuses at the first-trimester ultrasound scan and pregnancies not terminated were included. Adverse pregnancy outcome was defined as a composite of miscarriage before 24 weeks of gestation, stillbirth at 24 weeks of gestation, or intrauterine fetal death of 1 or 2 fetuses. The study cohort was composed of 317 trichorionic triplet pregnancies, of which 70.0% of pregnancies underwent fetal reduction to a twin pregnancy, 2.2% of pregnancies were reduced to singleton pregnancies, and 27.8% of pregnancies were not reduced. Nonreduced triplet pregnancies had high risks of adverse pregnancy outcomes (28.4%), which was significantly lower in triplets reduced to twins (9.0%; difference, 19.4%, 95% confidence interval, 8.5%-30.3%). Severe preterm deliveries were significantly higher in nonreduced triplet pregnancies (27.9%) than triplet pregnancies reduced to twin pregnancies (13.1%; difference, 14.9%, 95% confidence interval, 7.9%-21.9%). However, triplet pregnancies reduced to twin pregnancies had an insignificantly higher risk of miscarriage (6.8%) than nonreduced twin pregnancies (1.1%; difference, 5.6%; 95% confidence interval, 0.9%-10.4%). Triplet pregnancies reduced to twin pregnancies had significantly lower risks of adverse pregnancy outcomes, severe preterm deliveries, and low birthweight than nonreduced triplet pregnancies. However, triplet pregnancies reduced to twin pregnancies were potentially associated with a 5.6% increased risk of miscarriage.

Analysis of Pregnancy Outcomes After Fetal Reduction in Monochorionic, Dichorionic, and Trichorionic Triplet Pregnancies

To compare the pregnancy outcomes of pregnancy outcomes after selective fetal reduction treatment in monochorionic, dichorionic, and trichorionic triplet pregnancies. We conducted a retrospective analysis of the clinical data of 118 pregnant women carrying triplets. All subjects underwent regular prenatal check-ups and were admitted for delivery at West China Second University Hospital, Sichuan University between January 1, 2012 and January 31, 2021. According to the chorionicity, the subjects were divided into a monochorionic group ( n=13), a dichorionic group ( n=44), and a trichorionic group ( n=61). Within each group, the subjects were further divided into two subgroups, a reduction group and an expectant treatment group, according to whether they underwent fetal reduction or not. The clinical data and pregnancy outcomes were compared between the subgroups within each group. In the monichorionic group, the reduction subgroup had a lower preterm birth rate and higher neonatal birth body mass than those of the expectant management subgroup, but the differences were not statistically significant. In the dichorionic and trichorionic groups, the rates of preterm delivery, neonatal hospitalization, and serious complications of the reduction subgroups were lower than those of the expectant subgroups ( P<0.05), while the neonatal birth body mass was higher in the reduction subgroups than that in the expectant subgroups ( P<0.05). In the dichorionic group, the incidence of intrahepatic cholestasis during pregnancy was lower in the reduction subgroup than that in the expectant treatment subgroup. In all 3 groups, there was no statistically significant difference between the subgroups in the incidence of gestational diabetes, hypertensive disorders of pregnancy, premature rupture of membranes, and postpartum hemorrhage. The survival curve analysis showed that women receiving fetal reduction during the first trimester had a lower risk of pregnancy loss and more significant prolonged of gestational age than those undergoing the procedure during the second trimester. Fetal reduction of triplets can significantly prolong the gestational age and improve the perinatal prognosis. In addition, selective reduction in the first trimester may lead to greater benefits than selective reduction in the second trimester does.

Pregnancy and obstetric outcomes of dichorionic and trichorionic triamniotic triplet pregnancy with multifetal pregnancy reduction: a retrospective analysis study

BackgroundIt is generally beneficial for triplet gestation or high-order multiple pregnancies to operate multifetal pregnancy reduction (MFPR) after assisted reproductive techniques. However, data on pregnancy outcomes is lacking regarding dichorionic triamniotic (DCTA) and trichorionic triplets (TCTA) pregnancy.MethodThis research analyzes the difference between 128 DCTA and 179 TCTA pregnancies with or without MFPR after in vitro fertilization/intracytoplasmic sperm injection cycles between January 2015 and June 2020. The subdivided subgroups of the two groups are reduction to singleton, reduction to dichorionic twins, and expectant management groups. We also compare the pregnancy and obstetric outcomes between 2104 dichorionic twins and 122 monochorionic twins.ResultThe research subgroups were DCTA to monochorionic singleton pregnancies (n = 76), DCTA to dichorionic twin pregnancies (n = 18), DCTA-expectant management (n = 34), TCTA to monochorionic singleton pregnancies (n = 31), TCTA to dichorionic twin pregnancies (n = 130), and TCTA-expectant management (n = 18). In DCTA-expectant management group, the complete miscarriage rate is dramatically higher, and the survival rate and the rate of take-home babies are lower. However, there was no difference between the rates of complete miscarriages, survival rates, and take-home babies in TCTA-expectant management group. But the complete miscarriage rate of DCTA-expectant management was obviously higher than that of TCTA-expectant management group (29.41 vs. 5.56%, p = 0.044). For obstetric outcomes, MFPR to singleton group had higher gestational week and average birth weight, but lower premature delivery, gestational hypertension rates and low birth weight in both DCTA and TCTA pregnancy groups (all p < 0.05). DCTA to monochorionic singleton had the lowest incidence of gestational diabetes, whereas The subdivided subgroups of TCTA had no significant difference in the incidence of gestational diabetes. Monochorionic twins have higher rates of complete, early, and late miscarriage, premature delivery, and late premature delivery, and lower survival rate (p < 0.05).ConclusionMFPR could improve gestational week and average birth weight, reducing premature delivery, LBW, and gestational hypertension rates in DCTA and TCTA pregnancies. Monochorionic twins have worse pregnancy and obstetric outcomes. MFPR to singleton is preferable recommended in the pregnancy and obstetric management of complex triplets with monochorionic pair.

Short-term and long-term outcomes of trichorionic triplet pregnancies with expectant management.

Reproductive endocrinologists recommend selective multifetal pregnancy reduction (MFPR) to save at least one or two babies, because triplet pregnancy is known to increase the risk of miscarriage and preterm delivery. However, recently improved obstetric and neonatal care may affect pregnancy outcomes differently in triplet pregnancies, which could alter practice. We compared the maternal, perinatal, and long-term outcomes of triplet pregnancies managed expectantly with those of pregnancies reduced to twins. In this retrospective cohort study, we reviewed the clinical records of 552 trichorionic triplet pregnancies for obstetric, perinatal, and neurodevelopmental outcomes, which consisted of the expectant management (EM) group (n=225) and MFPR group (n=327), in Seoul National University Hospital and CHA Bundang Medical Center from January 2006 to December 2018. Neuromotor development was evaluated using the Korean-Ages and Stages Questionnaire, Bayley-III tests, and/or Gross Motor Function Measure. The two groups were compared for the following outcomes: (1) nonviable pregnancy loss before 23weeks, (2) preterm birth before 32weeks of gestation, (3) fetal and neonatal survival and (4) long-term neurodevelopmental outcomes. There were no differences in maternal age, body mass index, nulliparity or previous preterm birth between the two groups. The risk of nonviable pregnancy loss was lower in the EM groupthan that in the MFPR group (2 [0.9%] vs 21 [6.4%], p=0.001). The risk of preterm delivery before 34weeks of gestation was lower in the MFPR group (adjusted odds ratios [aOR]=0.47, 95% confidence interval [CI] 0.30-0.73, p=0.001).The survival rate of neonates until discharge (644 [95.4%] vs 572 [87.5], p< 0.001)and the rate of pregnancies with at least one survivor (220 [97.8%] vs 301 [92.0], p=0.002)were higher in the EM group than those in the MFPR group. In the MFPR group, the risk of developmental delay (aOR=2.89, 95% CI 1.38-6.02, p=0.005) was higher. In trichorionic triplet pregnancies, the possibility of EM to improve survival and reduce the risk of developmental delay has been shown.

Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre experience

ObjectivesIn trichorionic triplet pregnancies, multifetal pregnancy reduction (MFPR) reduces the risk of preterm birth, neonatal morbidity and mortality without increasing miscarriage. A similar benefit has been suggested in dichorionic triamniotic (DCTA) pregnancy, but multiple methods are currently used. This study investigates if the method of reduction used in DCTA triplet pregnancy influences the evidence of benefit from MFPR. MethodsThis is a retrospective cohort study of DCTA pregnancies between 2010 and 2019 who attended a single UK fetal medicine tertiary referral center. Cohorts were defined based on MFPR decision and method. The primary outcome was offspring survival until neonatal discharge. The secondary outcomes included miscarriage, preterm birth, livebirth, rates of small for gestational age (SGA) neonates, ans maternal morbidity. To evaluate the differences in neonatal survival until discharge we used Cox proportional regression to calculate hazard rates (HR) and 95% confidence intervals (CI). Differences in secondary outcomes were compared using univariate analysis. ResultsThe study reports the outcomes for 83 DCTA pregnancies. MFPR to DCDA twins was chosen in 19 pregnancies (14 radiofrequency ablation, RFA; 5 intrafetal laser, IFL); in 9 pregnancies selective reduction to a singleton was performed by KCl injection. The rate of pregnancies in with ≥ 1 fetus born alive was not different between groups (p = 0.90). However, the number of expected neonates alive at discharge from hospital was highest in the RFA group (89%, HR 0.28, 95% CI 0.21–0.87, p = 0.02). Rates of premature delivery before 32 weeks (p = 0.02), low birth weight (p < 0.001) and birthweight < 10th percentile (p = 0.01) were all elevated in the expectant management group, compared to women who opted for reduction. There was no difference in miscarriage between groups. ConclusionsOur study suggests that MFPR by RFA, an established and widely available procedure, is of benefit in promoting neonatal survival until discharge in DCTA triplets.

Clinical outcomes of multifetal pregnancy reduction in trichorionic and dichorionic triplet pregnancies: A retrospective observational study

ObjectiveTo observe the pregnancy and perinatal outcomes of trichorionic triplet (TCT) and dichorionic triplet (DCT) pregnancies with or without multifetal pregnancy reduction (MFPR). Materials and methodsThis was a retrospective study of 732 TCT and 118 DCT pregnancies after IVF/ICSI cycles between October 1999 and May 2014 at the Reproductive & Genetic Hospital of CITIC-Xiangya. The TCT and DCT groups were subdivided into three subgroups: MFPR to single fetus group, MFPR to twins group and expectant group. Pregnancy and perinatal outcomes were compared between different subgroups. ResultsThe resulting subgroups were TCT-Expectant (n = 40), TCT to twin (n = 610), TCT to single (n = 22), DCT-Expectant (n = 17), DCT to twin (n = 50), and DCT to single (n = 22). The groups with MFPR had the better pregnancy and perinatal outcomes. Meanwhile, the significantly higher abortion rates but lower live birth and take home baby rates were found in TCT-Expectant group and DCT-Expectant group (all P < 0.05). Besides, the abortion rate of DCT-Expectant group was much higher than TCT-Expectant group (41% verse 15%, P = 0.032). As for the perinatal outcomes, retaining single fetus group showed the advantage of higher birth weight, and elder gestational age in both DCT and TCT pregnancies (all P < 0.05). ConclusionFor DCT and TCT pregnancies, MFPR application could reduce the miscarriage rate, while improving live birth and take home baby rates compared to the expectant groups. Especially, when reduced to a single fetus, MFPR could provide the better perinatal outcomes.

Trichorionic triplet pregnancies: the effectiveness of multifetal pregnancy reduction after in vitro fertilization-embryo transfer

Trichorionic triplet pregnancies: the effectiveness of multifetal pregnancy reduction after in vitro fertilization-embryo transfer

Trichorionic Triamniotic Triplets After Single Embryo Transfer: A Case Series and Literature Review

Objectives: Monozygotic triplet pregnancy very rarely occurs in assisted reproductive technology (ART) treatment. The present study reported two cases of trichorionic triplet pregnancies after single embryo transfer (SET) and reviewed the literature in this regard. Case Presentation: In the first case, a 29-year-old female underwent the long protocol using gonadotropin-releasing hormone analogue and one full blastocyst was transferred in a fresh cycle. At 6 gestational weeks, three gestational sacs were clearly observed, while only one fetus with fetal heart beat was found after one week. In the second case, a 39-year-old female underwent intracytoplasmic sperm injection treatment and seven embryos were frozen accordingly. After assisted hatching, one completely expanded blastocyst was transferred during a hormone replacement cycle. Three gestational sacs with three yolk sacs were observed at 6 gestational weeks. Finally, two fetuses with fetal heart beat were found after one week. Conclusions: Overall, although the developmental mechanisms of monozygotic triplets are unknown, clinicians should be aware of the possibility of multiple pregnancies under SET.

P15.10: Embryo reduction in trichorionic triplets: effect on time to delivery and birthweight discordance

The aim of the study was to assess the effects of embryo reduction (ER) in trichorionic triplet pregnancies on the gestational age (GA) at delivery and the intertwin birthweight (BW) discordance. This was a retrospective cohort study. ER was performed before 16 weeks' gestation in all pregnancies via the transabdominal approach. Dichorionic, as well as monochorionic, triplets and triplet pregnancies reduced to one embryo were excluded from analysis. We compared the GA at delivery and the prevalence of intertwin BW discordance greater than 20% in trichorionic triplet pregnancies reduced to twins with primary dichorionic twins. We identified 52 reduced trichorionic triplet pregnancies which underwent ER and 226 primary dichorionic twin pregnancies. The procedure-related fetal loss rate was 1.9%. Reduced twin pregnancies had significantly lower GA at delivery than the primary twins (median 34.0, IQR 31.0-36.71 vs 36.71, IQR 34.71-37.57 weeks; p<0.001). Stratified according to the GA at delivery, reduced twins had an increased rate of preterm birth below 24 weeks [OR: 7.23 (95%CI: 1.96 to 26.69), P=0.003], between 24 and 28 weeks [OR: 4.38 (95%CI: 1.60 to 11.99), P=0.005], between 28 and 34 weeks [OR: 2.44 (95%CI: 1.29 to 4.63),P=0.007], and before 34 weeks' gestation [OR: 5.44 (95%CI: 2.84 to 10.42),P<0.001]. There were no significant difference between reduced and primary dichorionic twins regarding BW discordance >20% (15.3% vs. 18.1%, respectively P=0.61). Embryo reduction is not associated with increased incidence of BW discordance, but is associated with delivery on an average 2-3 weeks earlier when compared to the primary dichorionic twins.

Obstetric Outcome in Dichorionic Versus Trichorionic Triplet Pregnancies After IVF-ET [22H

Obstetric Outcome in Dichorionic Versus Trichorionic Triplet Pregnancies After IVF-ET [22H

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.

Perinatal and obstetric outcomes of dichorionic vs trichorionic triplet pregnancies

Clinical management and outcome of multiple gestation can be affected by chorionicity. In triplet pregnancies, fetal death has been associated with dichorionic (DC) and monochorionic placentation. Studies evaluating triplet pregnancy outcomes in relation to chorionicity have been few and may not reflect contemporary antenatal and neonatal care. The objective of this study was to compare obstetric and perinatal outcomes in DC and trichorionic (TC) triplet pregnancies. We performed a retrospective cohort study of triplet pregnancies that delivered at ≥20 weeks' gestation at 2 Chicago area hospitals from January 1999 through December 2010. Chorionicity was determined by pathology specimen. Maternal and infant charts were reviewed for obstetric and perinatal outcomes. The study population included 159 pregnancies (477 neonates) of which 108 were TC (67.9%) and 51 were DC (32.1%). Over 94% of mothers in this study had all 3 infants survive to discharge regardless of chorionicity. No difference was found in perinatal mortality rate between DC and TC triplets (3.3% vs 4.6%; P= .3). DC triplets were significantly more likely to be very low birthweight (41.8% vs 22.2%; odds ratio, 2.2; 95% confidence interval, 1.2-4.2; P= .02) and to deliver at <30 weeks (25.5% vs 8.3%; odds ratio, 6.1; 95% confidence interval, 1.9-19.4; P=.002) compared to TC triplets. Criteria for twin-twin transfusion syndrome (TTTS) were present in 3 DC triplet pregnancies (5.9%). Neonates in pregnancies complicated by TTTS were less likely to survive 28days as compared to neonates from DC pregnancies that were not affected by TTTS (P= .02) or TC neonates (P= .02) Neonatal survival was similar in DC pregnancies not affected by TTTS and TC pregnancies (98.6% and 96.6%; P= .7). Although perinatal mortality did not correlate with chorionicity, DC pregnancies were more likely to deliver <30 weeks' gestational age and have very low birthweight neonates. Neonatal mortality appears to be mediated by the presence or absence of TTTS as 28-day survival was worse in DC pregnancies complicated by TTTS, but similar between DC pregnancies not affected by TTTS and TC pregnancies.

Pregnancy outcome of early multifetal pregnancy reduction: triplets to twins versus triplets to singletons

Multifetal pregnancy reduction (MPR) of triplets to twins results in improved pregnancy outcomes compared with triplet gestations managed expectantly. Perinatal outcomes of early transvaginal MPR from triplets to twins were compared with reduction from triplets to singletons. Seventy-four trichorionic triplet pregnancies that underwent early transvaginal MPR at 6–8 weeks gestation were included. Cases were divided into two groups according to the initial procedure: reduction to twin (n = 55) or to singleton (n = 19) gestations. Infants from triplet pregnancies reduced to twins were delivered earlier (36.6 versus 37.9 weeks; P = 0.04) and had lower mean birth weights (2364 g versus 2748 g; P = 0.02) compared with those from triplets reduced to singleton gestations. The rates of pregnancy loss before 24 weeks (3.6% versus 5.3%), as well as of preterm delivery before 32 and 34 weeks of gestation (0% versus 5.3% and 7.3% versus 5.3%, respectively) were similar between the twin and singleton pregnancies. No significant difference was found in the prevalence of gestational diabetes (15.1% versus 5.6%) or gestational hypertension (24.5% versus 16.7%) between the groups. Selective reduction of triplet pregnancies to singleton rather than twin gestations is associated with improved outcomes.

OP11.08: The influence of chorionicity on miscarriage and fetal loss in triplet pregnancies

The aim of this study was to compare fetal loss rates between trichorionic (TC) triplet pregnancies and those with mixed chorionicity. This was a retrospective cohort study of all triplet pregnancies managed at a single tertiary center over ten year period. Triplet pregnancies which underwent selective reduction were not included in the analysis. Cumulative fetal loss rates for TC and dichorionic (DC) triplet pregnancies from 11 to 36 weeks gestation were analysed using Kaplan-Meier survival curves to assess the difference in mortality between TC and DC twins. Logistic regression analysis was performed to investigate pregnancy and ultrasound characteristics independently associated with the risk of fetal loss. 94 triplet pregnancies (35 trichorionic and 59 mixed chrionicity) were included in the analysis. The total fetal loss rate in TC and in triplet with mixed chorionicity was 3.81% (4/105 fetuses) and 31.0% (55/177), respectively (OR 3.49, 95% CI 1.2 to 10.4). The trend in total fetal loss rate was significantly higher in triplets with mixed chorionicity in all gestation (log rank test, p < 0.0001). The results of the logistic regression analysis showed that mixed chorionicity was independently associated with the occurrence of feta loss in triplets (OR: 1.87, 95% CI 1.5-2.9). The rate of fetal loss remained significantly higher in triplets with mixed chorionicity even afetr exclusion of cases complicated by twin–twin transfusion syndrome (p00.002). Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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.

Selective Fetal Reduction in Triplet Pregnancy: Indian Experience — A Retrospective Review of 32 Cases

ABSTRACT Aim To review the effects of selective fetal reduction in trichorionic triplet pregnancy with focus on risk of miscarriage and preterm delivery in Indian women and thus provide local data for counseling the prospective parents in similar situation. Materials and methods This retrospective study reviewed the pregnancy outcome of 32 sets of triplet pregnancies following fetal reduction. All mothers had trichorionic triplet pregnancy with three live fetuses at 10 to 11 weeks of gestation. One to two milliliter ml of 10% potassium chloride (KCl) was injected into the heart of the target fetus to achieve asystole. Results The miscarriage (pregnancy loss before 24 completed weeks) rate in our study was 3.12%. The delivery in our study at. 32 and. 35 weeks were 6.45 and 51.61% respectively. The mean gestational age (mean ± SD) of the mothers was 242.58 ± 12.93 days. Regarding the birthweight of neonates, 5.08% babies were &lt;1500 gm, 89.83% were between 1500 and. 2500 gm and 5.08% were &gt; 2500 gm. The mean birth weight (mean ± SD) of the babies was 1921.18 ± 339.78 gm. There was no neonatal death in this cohort. Conclusion Our study results, when compared with ‘expectant management’ group of two European studies as there was no control in our study, appeared significantly better in terms of gestational age at delivery and neonatal birth weight. Selective fetal reduction remains an effective option to Indian women with trichorionic triplet pregnancy. How to cite this article Chaudhury K, Mukherjee K. Selective Fetal Reduction in Triplet Pregnancy: Indian Experience — A Retrospective Review of 32 Cases. J South Asian Feder Obst Gynae 2014;6(3):144-150.

Trichorionic and Dichorionic Triplet Pregnancies at 10-14 Weeks: Outcome after Embryo Reduction Compared to Expectant Management

Objective: To compare the outcome of trichorionic triplet (TCT) and dichorionic triplet (DCT) pregnancies managed expectantly and those with embryo reduction (ER) at 10-14 weeks to twins or singletons. Methods: This was a retrospective study of triplet pregnancies with 3 live fetuses managed expectantly or by ER. Data were combined with the results of previous studies that used similar entry criteria and outcome measures. The management options were compared for rates of miscarriage and preterm birth <33 weeks. Results: In TCTs managed expectantly (n = 358), the rates of miscarriage and preterm birth were 3.1 and 35.1%. Compared to the expectantly managed TCTs, the rate of miscarriage was higher and preterm birth lower in TCTs with ER to 2 fetuses (n = 833, 7.3 and 13.1%, respectively) and TCTs with ER to 1 fetus (n = 78, 11.5 and 8.7%). In DCTs managed expectantly (n = 136), the rates of miscarriage and preterm birth were 8.8 and 46.0%. In DCTs with ER to 2 fetuses (n = 15) or ER to 1 fetus (n = 42), there was a non-significant increase in miscarriage (13.3 and 16.7%, respectively) and decrease in preterm birth (23.1 and 8%, respectively). Conclusions: In TCT and DCT pregnancies, ER increases the rate of miscarriage but reduces the rate of preterm birth.

Retain singleton or twins? Multifetal pregnancy reduction strategies in triplet pregnancies with monochorionic twins

To assess the effectiveness and feasibility of retaining a singleton or twins for multifetal pregnancy reduction (MFPR) in triplet pregnancy with monochorionic twins. This retrospective study was conducted from January 2006 to September 2011 at a university reproductive medical center. Multifetal pregnant patients (n=35) with dichorionic triplets underwent MFPR in the first trimester to reduce one or both monochorionic twins. These cases were divided into two groups: Group A (9 MFPR cases to reduce one monochorionic twin) and Group B (26 MFPR for both monochorionic twins). Control A (for Group A) included another 18 cases of trichorionic triplet reduction to twins; Control B (for Group B) included 35 cases of trichorionic triplet reduction to singletons. MFPR was performed during the same period for all groups. Pregnancy outcomes were compared between groups. Patients were 28-39 years old; the average gestation for fetal reduction was 6-8 weeks. The early abortion rate was lower in Group A than Group B (0 versus 11.5%, p=0.339), but the late abortion rate was significantly higher in Group A. (33.3% versus 0, p=0.000). Groups A and B did not differ significantly in premature labor rate, term birth rate, gestation at delivery and take-home baby rate. The rate of very low and low birth weight was significantly higher in Group A than Group B (50% versus 0, p=0.001), and the average birth weight was significantly lower in Group A (2391.7±318.5 versus 3119.6±523.9, p=0.001). Group A had significantly more low birth-weight newborns than Control A (50% versus 13.3%, p<0.05 [0.024]). Group B (retained singleton) had similar pregnancy outcomes and neonatal conditions as Control B. Retaining a singleton is always the best choice when deciding about using MFPR to improve pregnancy outcomes. For patients having a triplet pregnancy with monochorionic twins and strongly desiring to keep twins, MFPR in one monochorionic twin was feasible by aspirating embryonic parts early in gestation (6-8 weeks) with no drug injection. Pregnancy outcomes are similar with twin reduction in trichorionic triplet pregnancy.

Fetal reduction of triplet pregnancy: one or two?

To review outcomes following reductions in trichorionic triplet pregnancies at our institution. Retrospective analysis of the outcome of trichorionic triamniotic triplets reduced to singletons (group I, n = 44) or twins (group II, n = 136) at 10 and 12 weeks of gestation. Reduction to one or two was based on parent's preference, hence unrelated to any specific obstetrical or maternal issue. Early fetal loss rate (e.g. <24 weeks) was 9.1% in group I versus 5.1% in group II (p = 0.83). In group I, the take-home baby rate was 86.4% versus 91.9% in group II (p = 0.8). In group I, 17.5% of the women gave birth between 33 and 36(+6) weeks of gestation versus 40.6% in group II (p = 0.026). Delivery beyond 37 weeks was 72.5% in group I and 46.9% in group II (p = 0.01). Intrauterine growth restriction rate was 27.0% in group I versus 45.0% in group II (p = 0.049). Reduction to one rather than two fetuses led to significantly higher term delivery rate without significant differences in fetal loss rate or take-home baby rate.