TY - JOUR
T1 - The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation
AU - Van De Mheen, Lidewij
AU - Everwijn, Sheila M.P.
AU - Knapen, Maarten F.C.M.
AU - Oepkes, Dick
AU - Engels, Melanie
AU - Manten, Gwendolyn T.R.
AU - Zondervan, Hans
AU - Wirjosoekarto, Soetinah A.M.
AU - Van Vugt, John M.G.
AU - Erwich, Jan Jaap H.M.
AU - Nij Bijvank, Sebastiaan W.A.
AU - Ravelli, Anita
AU - Heemelaar, Steffie
AU - Van Pampus, Maria G.
AU - De Groot, Christianne J.M.
AU - Mol, Ben W.J.
AU - Pajkrt, Eva
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Objective The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. Study Design 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. Conclusion 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.
AB - Objective The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. Study Design 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. Conclusion 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.
KW - multifetal pregnancy reduction
KW - multiple pregnancy
KW - pregnancy outcome
UR - http://www.scopus.com/inward/record.url?scp=84908331132&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2014.04.023
DO - 10.1016/j.ajog.2014.04.023
M3 - Article
C2 - 24769009
AN - SCOPUS:84908331132
SN - 0002-9378
VL - 211
SP - 536.e1-536.e6
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 5
ER -