Comparative analysis of perinatal outcome of spontaneous pregnancy reduction and multifetal pregnancy reduction in triplet pregnancies conceived after assisted reproductive technique.
BACKGROUND
With the advent of assisted reproductive treatment options, the incidence of multiple pregnancies has increased. Although the need for elective single embryo transfer is emphasized time and again, its uniform applicability in practice is yet a distant goal. In view of the fact that triplet and higher order pregnancies are associated with significant fetomaternal complications, the fetal reduction is a commonly used option in such cases. This retrospective study aims to compare the perinatal outcome in patients with triplet gestation who have undergone spontaneous fetal reduction (SFR) as against those in whom multifetal pregnancy reduction (MFPR) was done.


METHODS
In the present study, eighty patients with triplet gestation at 6 weeks were considered. The patients underwent SFR or MFPR at or before 12-13 weeks and were divided into two groups (34 and 46), respectively.


RESULTS
Our study found no statistical difference in perinatal outcome between the SFR and MFPR groups in terms of average gestational age at delivery, abortion rate, preterm delivery rate, and birth weight. The study shows that the risk of aborting all fetuses after SFR is three times (odds ratio [OR] = 3.600, 95% confidence interval [CI] = 0.2794-46.388) that of MFPR in subsequent 2 weeks. There were more chances of loss of extra fetus in SFR (23.5%) group than MFPR group (8.7%) (OR = 3.889, 95% CI = 1.030-14.680). As neither group offers any significant benefit from preterm delivery, multiple pregnancies continue to be responsible for preterm delivery despite fetal reduction.


CONCLUSIONS
There appears to be some advantages of MFPR in perinatal outcome when compared to SFR, especially if the latter happens at advanced gestation. Therefore, although it is advisable to wait for SFR to occur, in patients with triplet gestation at 11-12 weeks, MFPR is a viable option to be considered.
Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
Shilpa
S
Bhandari
Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
Ishita
I
Ganguly
Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
Pallavi
P
Agrawal
Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
Shweta
S
Bhandari
Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
Aparna
A
Singh
Department of Reproductive Medicine and Surgery, Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India.
Nitika
N
Gupta
Fetal reduction; multiple pregnancies; triplet gestation