Fetal reduction in triplet gestations: twins still fare better.
BACKGROUND
Reduction of fetal number has been offered in high order multiple gestations but is still controversial in triplets. Since recent advances in neonatal and obstetric care have greatly improved outcome, the benefits of multifetal pregnancy reduction (MFPR) may no longer exist in triplet gestations.


OBJECTIVE
To evaluate if fetal reduction of triplets to twins improves outcome.


METHODS
We analyzed the outcome of 80 triplet gestations cared for at Rambam Health Care Campus in the last decade; 34 families decided to continue the pregnancy as triplets and 46 opted for MFPR to twins.


RESULTS
The mean gestational age at delivery was 32.3 weeks for triplets and 35.6 weeks for twins after MFPR. Severe prematurity (delivery before 32 gestational weeks) occurred in 37.5% and 7% of twins. Consequently, the rate of severe neonatal morbidity (respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage) and of neonatal death was significantly higher in unreduced triplets, as was the length of hospitalization in the neonatal intensive care unit (31.4 vs. 15.7, respectively). Overall, the likelihood of a family with triplets to take home all three neonates was 80%; the likelihood to take home three healthy babies was 71.5%.


CONCLUSIONS
MFPR reduces the risk of severe prematurity and the neonatal morbidity of triplets. A secondary benefit is the reduction of cost of care per survivor. Our results indicate that MFPR should be offered in triplet gestations.
Department of Obstetrics and Gynecology, Rambam Health Care Center, Haifa, Israel. a_drugan@rambam.health.gov.il
Arie
A
Drugan
Neonatal Intensive Care Unit, Rambam Health Care Center, Haifa, Israel.
Irena
I
Ulanovsky
Department of Obstetrics and Gynecology, Rambam Health Care Center, Haifa, Israel.
Yechiel
Y
Burke
Neonatal Intensive Care Unit, Rambam Health Care Center, Haifa, Israel.
Shraga
S
Blazer
Department of Obstetrics and Gynecology, Rambam Health Care Center, Haifa, Israel.
Amir
A
Weissman
D000328:Adult; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D007557:Israel; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D059286:Pregnancy, Triplet / Q000706:statistics & numerical data*; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D014310:Triplets / Q000706:statistics & numerical data; D014427:Twins / Q000706:statistics & numerical data