title: Comparison of the outcomes between reduced and nonreduced triplet pregnancies achieved by Assisted Reproductive Technology.
abstract: BACKGROUND
  In recent years, the significant increase in multiple pregnancies as a result of assisted reproductive technology (ART) has introduced the concept of multifetal reduction techniques. However, it is still unclear whether there are significant advantages of using this technique.
  
  
  OBJECTIVE
  To compare the outcomes of triplet pregnancies achieved by ART managed expectantly with those receiving fetal reduction interventions.
  
  
  METHODS
  In this retrospective study of 115 triplet pregnancies, 57 pregnancies were reduced to twins while 58 were managed expectantly.
  
  
  RESULTS
  The fetal loss rate before 24 weeks did not differ between reduced and nonreduced pregnancies (12.3% vs 12.1%). However, the results of those using fetal reduction techniques showed a lower incidence of preterm labour (26.3% vs 50%, P = 0.009), higher mean gestational age at delivery (35.1 ± 2.6 vs 32.4 ± 3.6 weeks, P = 0.002) and higher mean birthweights compared with the control group (2188 ± 547 vs 1674 ± 546 g, P < 0.001). The perinatal mortality rate was significantly lower in reduced triplets compared with those expectantly managed (6% vs 17.6%, P = 0.007). The rate of live birth was 94% in reduced and 82.4% in nonreduced pregnancies (P = 0.007). The percentages of neonates admitted to the neonatal intensive care unit (NICU) were 27.7 and 62.7% in reduced and nonreduced pregnancies, respectively (P < 0.001).
  
  
  CONCLUSIONS
  In this observational cohort study reduction of triplets to twins decreased prematurity and increased birthweight without an increase in fetal loss. Additionally, there was a lower perinatal mortality, higher live birth rate and lower NICU admission.
authors.affiliation: Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Shiva
authors.forename: Ladan
authors.initials: L
authors.lastname: Mohammadi Yeganeh
authors.forename: Elaheh
authors.initials: E
authors.lastname: Mirzaagha
authors.forename: Mohammad
authors.initials: M
authors.lastname: Chehrazi
authors.forename: Narges
authors.initials: N
authors.lastname: Bagheri Lankarani
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D059286:Pregnancy, Triplet; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies
keywords: assisted reproductive techniques; fetal loss; multifetal pregnancy reduction; prematurity; triplet pregnancies