Outcome of monochorionic triamniotic triplet pregnancies: Expectant management versus fetal reduction

Prenat Diagn. 2022 Jul;42(8):970-977. doi: 10.1002/pd.6161. Epub 2022 May 4.

Abstract

Objective: To compare the outcomes of monochorionic triamniotic (MCTA) triplets managed expectantly with those reduced to twins.

Method: This was a retrospective cohort study comparing expectant management (EM) with fetal reduction (FR) to twins in 43 consecutive MCTA triplets with 3 live fetuses at 11-14 weeks between 2012 and 2021.

Results: Nineteen patients managed expectantly and 24 triplets reduced to twins were included. The rate of pregnancy with at least one survivor was 84.2% in the EM group and 66.7% in the FR group (P = 0.190). Compared to the EM cases, triplets reduced to twins had a higher median gestational age at delivery (36.0 vs. 33.3 weeks; P < 0.001), a higher mean birth weight (2244.3 ± 488.6 g vs. 1751.1 ± 383.2 g; P < 0.001) and a lower risk of preterm birth before 34 weeks (11.8% vs. 64.7%; P = 0.001). There were no significant differences in the risk of miscarriage, pregnancy complications and composite adverse neonatal outcomes.

Conclusion: In MCTA triplets, FR to twins could reduce the risk of preterm birth, whereas EM seems to be a reasonable choice when the priority is at least one survivor. However, due to the small sample size of this study, these findings must be interpreted with great caution.

MeSH terms

  • Birth Weight
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Pregnancy Reduction, Multifetal / adverse effects
  • Pregnancy, Triplet*
  • Premature Birth* / epidemiology
  • Premature Birth* / etiology
  • Premature Birth* / prevention & control
  • Retrospective Studies
  • Triplets
  • Watchful Waiting