title: [Clinical analysis of pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy].
abstract: OBJECTIVE
  To investigate and evaluate the pregnancy outcomes and fetal loss after fetal reduction of triplets to twins or singleton pregnancy.
  
  
  METHODS
  282 cases of triplets who received multi-fetal pregnancy reduction (MFPR) at Shandong Provincial Hospital affiliated to Shandong University were recruited from Sep 2001 to Mar 2014. According to the remaining fetal number after MFPR, 231 cases were opted to reduce to twins (twins group) while 51 cases were opted to singleton pregnancy (singleton group). The indication of the former group was fetal abnormalities under ultrasound or on patients' demand; while the indication for the later group included dichorionic triamniotic (DCTA) triplets or patients' aspiration. Potassium chloride was injected into the targeted fetal heart until cardiac standstill was obtained. The pregnancy outcomes, gestational age at delivery, birth weight of newborns of the two groups were recorded. Successful pregnancy was defined as take-home at least one baby.
  
  
  RESULTS
  (1) The overall rate of successful pregnancy was 91.5% (258/282). There were 413 neonates in the twins group, including 4 neonatal deaths and 409 live babies, with the successful rate of 90.5% (209/231). There were 49 neonates in the singleton group, including 2 cases of fetal loss. Thus the successful rate was 96.1% (49/51). There was no difference of successful pregnancy rate between the two groups (P>0.05). (2) The mean gestational age at operation for the twins group and singleton group were (16.5±3.5) weeks and (14.2±2.0) weeks, respectively. Each group was divided into three periods, 11-13(+6) weeks, 14-16(+6) weeks and ≥17 weeks. In the twins group, the cases in each time period were 129 (55.8%, 129/231), 50 (21.6%, 50/231) and 52 (22.5%, 52/231), respectively. While in the singleton group, the cases in each time period were 27 (53%, 27/51), 16 (31%, 16/51) and 8 (16%, 8/51). There was no difference between the two groups at each time period (P>0.05). (3) The fetal loss rate in the twins group were 7% (9/129), 12% (6/50), 10% (5/52) at each time period, respectively. While for the singleton group they were 4% (1/27), 0 (0/16) and 1/8, respectively. There was no significant difference between the two groups at each time period (P>0.05). (4) The mean birth weight of the twins group was lower than the singleton group [(2,555±447) g vs (3,084±550) g, respectively, P<0.05]. The rates of low birth weight infants (<2,499 g) in the twins group and the singleton group were 45.5% (188/413) and 8% (4/49), respectively (P<0.05). The rate of very low birth weight infants (≤1,499 g) was 3.9% (16/413) in the twins group compared with 0 (0/49) in the singleton group (P>0.05). (5) The gestational age at delivery of the twins group was earlier than the singleton group [(36.2±2.4) weeks vs (38.3±2.2) weeks, respectively, P<0.05]. The labor rate of the two groups was significantly different for both 34-36(+6) weeks and ≥ 37 weeks (P<0.05). The full-term delivery rate in the twins group was 47.6% (110/231), and was 88.2% (45/51) in the singleton group (P < 0.05). The fetal loss rate before 28 weeks did not differ between the two groups [8.7% (20/231) vs 3.9% (2/51), P>0.05].
  
  
  CONCLUSIONS
  Reduction to one fetus led to significantly better outcome than two fetuses, with no significant difference in fetal loss rate. It is better to advise patients with triplets reduce to singleton pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.
authors.forename: Shanling
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China; Email: wxt65@vip.163.com.
authors.forename: Xietong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.
authors.forename: Yanyun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Hou
mesh_terms: D001724:Birth Weight; D005260:Female; D046689:Fetal Mortality; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D059286:Pregnancy, Triplet; D014310:Triplets; D014427:Twins