The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation.
OBJECTIVE
The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Departments of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands. Electronic address: lidewijvandemheen@gmail.com.
Lidewij
L
van de Mheen
Academic Medical Center, Amsterdam, The Netherlands.
Sheila M P
SM
Everwijn
Erasmus Medical Center, Rotterdam, The Netherlands.
Maarten F C M
MF
Knapen
Leiden University Medical Center, Leiden, The Netherlands.
Dick
D
Oepkes
Departments of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands.
Melanie
M
Engels
University Medical Center, Utrecht, The Netherlands.
Gwendolyn T R
GT
Manten
Rijnstate Hospital, Arnhem, The Netherlands.
Hans
H
Zondervan
Maastricht University Medical Center, Maastricht, The Netherlands.
Soetinah A M
SA
Wirjosoekarto
Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
John M G
JM
van Vugt
University Medical Center, University of Groningen, Groningen, The Netherlands.
Jan Jaap H M
JJ
Erwich
Isala Clinics, Zwolle, The Netherlands.
Sebastiaan W A
SW
Nij Bijvank
Department of Epidemiology, Academic Medical Center, Amsterdam, The Netherlands.
Anita
A
Ravelli
De Tjongerschans Hospital, Heerenveen, The Netherlands.
Steffie
S
Heemelaar
Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Maria G
MG
van Pampus
Departments of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands.
Christianne J M
CJ
de Groot
Robinson Institute, School of Paediactrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
Ben W J
BW
Mol
Academic Medical Center, Amsterdam, The Netherlands.
Eva
E
Pajkrt
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D059286:Pregnancy, Triplet; D059285:Pregnancy, Twin; D047928:Premature Birth; D012189:Retrospective Studies
multifetal pregnancy reduction; multiple pregnancy; pregnancy outcome