학술논문
The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation
Document Type
Academic Journal
Author
van de Mheen, Lidewij; Everwijn, Sheila M.P.; Knapen, Maarten F.C.M.; Oepkes, Dick; Engels, Melanie; Manten, Gwendolyn T.R.; Zondervan, Hans; Wirjosoekarto, Soetinah A.M.; van Vugt, John M.G.; Erwich, Jan Jaap H.M.; Nij Bijvank, Sebastiaan W.A.; Ravelli, Anita; Heemelaar, Steffie; van Pampus, Maria G.; de Groot, Christianne J.M.; Mol, Ben W.J.; Pajkrt, Eva
Source
American Journal of Obstetrics and Gynecology. Nov 01, 2014 211(5):536e1-536e6
Subject
Language
English
ISSN
0002-9378
Abstract
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.