title: Embryo reduction in dichorionic triplets to dichorionic twins by intrafetal laser.
abstract: OBJECTIVE
  To describe a new technique for embryo reduction (ER) in dichorionic triplet (DCT) pregnancies.
  
  
  METHODS
  In 22 DCT pregnancies, ER to dichorionic twins was carried out at 11.3-13.9 weeks' gestation by ultrasound-guided laser ablation of the pelvic vessels of one of the monochorionic twins.
  
  
  RESULTS
  Intrafetal laser was successfully carried out in all cases, but ultrasound examination within 2 weeks of the procedure demonstrated that the co-twin had died in 11 cases and was alive in the other 11. In the dichorionic group there was one miscarriage at 23 weeks due to cervical incompetence and in the other 10 cases there were two live births at a median gestational age of 35.0 (range 32.2-37.1) weeks. In the 11 cases where both monochorionic fetuses died the separate triplet was live born at a median gestation of 38.0 (range 32.2-40.5) weeks.
  
  
  CONCLUSIONS
  In the management of DCT pregnancies, ER to dichorionic twins by intrafetal laser is an additional option to the traditional ones of expectant management, ER by intrafetal injection of potassium chloride (KCl) to monochorionic twins or ER by KCl to singleton.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Petya
authors.initials: P
authors.lastname: Chaveeva
authors.forename: Przemek
authors.initials: P
authors.lastname: Kosinski
authors.forename: Cahit
authors.initials: C
authors.lastname: Birdir
authors.forename: Laszlo
authors.initials: L
authors.lastname: Orosz
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053685:Laser Therapy; D007834:Lasers; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D059286:Pregnancy, Triplet; D059285:Pregnancy, Twin; D012189:Retrospective Studies