Clinical dilemma in triplet pregnancy: when is it appropriate to intervene for a jeopardized fetus?
OBJECTIVE
To determine gestational age-specific risks of intervening to "rescue" a compromised fetus in triplet pregnancies.


METHODS
We analyzed retrospectively triplet pregnancies managed at New England Medical Center (July 1992-May 2000; n=97 pregnancies). For each week in gestation, we compared the chance of at least one of three infants developing complications of prematurity in Scenario A (delivery at that gestation to rescue the jeopardized fetus) with the chance of at least one of two infants from Scenario B (allowing the jeopardized fetus to die in utero to prolong pregnancy) developing that complication later in gestation.


RESULTS
We observed a decreased risk of at least one infant developing a specific complication in Scenario B than in Scenario A for all complications studied.


CONCLUSIONS
Comparison of triplet outcomes with the two surviving older newborns identifies important changes in risk between 25 and 32 weeks. These data enable physicians and parents to weigh acceptable risks with benefits.
Department of Pediatrics, Floating Hospital for Children, New England Medical Center, Boston, MA 02111, USA.
Liza
L
Konnikova
Karen
K
Harvey-Wilkes
Teresa
T
Marino
Sabrina
S
Craigo
Heber C
HC
Nielsen
D000328:Adult; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D012307:Risk Factors; D014310:Triplets