Multifetal Pregnancy Reduction of Trichorionic Triplet Gestations: What is the Benefit?

Abstract

Objective This study aims to determine the efficacy of multifetal pregnancy reduction (MFPR) in improving obstetrical outcomes for trichorionic triplet gestations.

Study Design Retrospective cohort study of patients with multiple gestations delivered by a single maternal-fetal medicine practice from 2005 to 2016. We compared patients with trichorionic triamniotic triplet gestations who underwent MFPR to those with an ongoing triplet pregnancy (TT), as well as primary dichorionic diamniotic twin gestations (DD). Logistic regression analysis was used to control for any differences at baseline.

Results There were 42 patients in the MFPR group, 43 women in the TT group, and 693 women in the DD group. Comparing MFPR to TT, the likelihood of preterm birth < 34 weeks was similar (31.0 vs. 39.5%, adjusted odds ratio [aOR]: 0.63, 95% confidence interval [CI]: 0.21, 1.87). There were no differences in gestational age at delivery, pregnancy loss < 24 weeks, or the likelihood of all, none, or at least two babies surviving to discharge. Mean birth weights were significantly higher and cesarean delivery rates lower for MFPR (2,128 vs. 1,836 g, p = 0.028 and 69 vs. 86%, aOR: 0.25, 95% CI: 0.06, 0.94) as compared with the TT group. MFPR had significantly worse outcomes than DD.

Conclusion In trichorionic triamniotic triplet pregnancies, our study suggests that obstetrical outcomes may not be as dramatically improved with MFPR as seen in older studies.

Keywords

triplet - multifetal pregnancy reduction - preterm birth - twins

• References

• 1 Martin JA, Hamilton BE, Ventura SJ. , et al. Births: final data for 2009. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics. Natl Vital Statistics Syst 2011; 60 (01) 1-70
• 2 Martin JA, Hamilton BE, Osterman MJ. ; Centers for Disease Control and Prevention. Three decades of twin births in the United States, 1980–2009. Available at: https://www.cdc.gov/nchs/products/databriefs/db80.htm . Accessed May 02, 2017
• 3 Conde-Agudelo A, Belizán JM, Lindmark G. Maternal morbidity and mortality associated with multiple gestations. Obstet Gynecol 2000; 95 (6 Pt 1): 899-904
• 4 Luke B, Brown MB. Contemporary risks of maternal morbidity and adverse outcomes with increasing maternal age and plurality. Fertil Steril 2007; 88 (02) 283-293
• 5 Sibai BM, Hauth J, Caritis S. , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol 2000; 182 (04) 938-942
• 6 Schwartz DB, Daoud Y, Zazula P. , et al. Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies. Am J Obstet Gynecol 1999; 181 (04) 912-914
• 7 Day MC, Barton JR, O'Brien JM, Istwan NB, Sibai BM. The effect of fetal number on the development of hypertensive conditions of pregnancy. Obstet Gynecol 2005; 106 (5 Pt 1): 927-931
• 8 Martin JA, Hamilton BE, Osterman M, Curtin SC, Matthews T. Births: final data for 2013. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics. Natl Vital Statistics Syst 2015; 64 (01) 1-65
• 9 Practice Committee of American Society for Reproductive Medicine; Practice Committee of Society for Assisted Reproductive Technology. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril 2013; 99 (01) 44-46
• 10 Åberg A, Mitelman F, Cantz M, Gehler J. Cardiac puncture of fetus with Hurler's disease avoiding abortion of unaffected co-twin. Lancet 1978; 2 (8097): 990-991
• 11 Dodd J, Crowther C. Multifetal pregnancy reduction of triplet and higher-order multiple pregnancies to twins. Fertil Steril 2004; 81 (05) 1420-1422
• 12 Lipitz S, Shulman A, Achiron R, Zalel Y, Seidman DS. A comparative study of multifetal pregnancy reduction from triplets to twins in the first versus early second trimesters after detailed fetal screening. Ultrasound Obstet Gynecol 2001; 18 (01) 35-38
• 13 Blickstein I. How and why are triplets disadvantaged compared to twins?. Best Pract Res Clin Obstet Gynaecol 2004; 18 (04) 631-644
• 14 Običan S, Brock C, Berkowitz R, Wapner RJ. Multifetal pregnancy reduction. Clin Obstet Gynecol 2015; 58 (03) 574-584
• 15 Dodd JM, Crowther CA. Reduction of the number of fetuses for women with a multiple pregnancy. Cochrane Database Syst Rev 2012; 10: CD003932
• 16 Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 2003; 3 (01) 6
• 17 Evans MI, Dommergues M, Wapner RJ. , et al. Efficacy of transabdominal multifetal pregnancy reduction: collaborative experience among the world's largest centers. Obstet Gynecol 1993; 82 (01) 61-66
• 18 Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH. Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod 2006; 21 (07) 1912-1917
• 19 van de Mheen L, Everwijn SM, Knapen MF. , et al. The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. Am J Obstet Gynecol 2014; 211 (05) 536.e1-536.e6
• 20 Drugan A, Ulanovsky I, Burke Y, Blazer S, Weissman A. Fetal reduction in triplet gestations: twins still fare better. Isr Med Assoc J 2013; 15 (12) 745-747
• 21 Antsaklis A, Souka AP, Daskalakis G. , et al. Embryo reduction versus expectant management in triplet pregnancies. J Matern Fetal Neonatal Med 2004; 16 (04) 219-222
• 22 Geva E, Lerner-Geva L, Stavorovsky Z. , et al. Multifetal pregnancy reduction: a possible risk factor for periventricular leukomalacia in premature newborns. Fertil Steril 1998; 69 (05) 845-850
• 23 Smith-Levitin M, Kowalik A, Birnholz J. , et al. Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations. Am J Obstet Gynecol 1996; 175 (4 Pt 1): 878-882