Fetal reduction of triplets increases duration of gestation

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1. Women with trichorionic triplets who underwent multifetal pregnancy reduction (MFPR) delivered at a greater gestational age than women with ongoing triplet pregnancy. 

2. Women who underwent reduction were more likely to have all fetuses intended to survive living at 1 week postpartum than women with triplet pregnancies. 

Evidence Rating Level: 2 (Good) 

Study Rundown: This study found that reduction of trichorionic triplet pregnancies to two fetuses was associated with longer gestations but had no impact on perinatal mortality. While there is substantial literature supporting the use of MFPR in pregnancies with four or more fetuses, its use in triplet pregnancies has not been well-studied. The present work suggests that MFPR also increases median gestational age in trichorionic triplet pregnancies.

This study is limited by retrospective design, small sample size, and differences in baseline characteristics between groups. Future studies that directly measure neonatal morbidity and longer term outcomes are needed to more fully characterize potential benefits of MFPR.

Click to read the study in AJOG

Relevant Reading: Risk of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management

In-Depth [retrospective cohort study]: This study evaluated differences in pregnancy outcomes between women with trichorionic triplet pregnancies who underwent reduction to 2 fetuses (n=86), women with ongoing triplet pregnancies (n=44), and women with primary twin pregnancies (n=824). Outcomes evaluated included gestational age, delivery <24 weeks, delivery <32 weeks, birth weight and overall neonatal morbidity.

Median gestational age at delivery was greatest for primary twins (37.1 weeks), next greatest for triplets reduced to twins (36.1 weeks) and least for ongoing triplets (33.3 weeks) (p<0.001). Infant birth weight followed a similar trend (p<0.001). Compared to a twin pregnancy, women with triplets reduced to twins were no more likely to deliver at <24 weeks while those with an ongoing triplet pregnancy were (p=0.03). Women who underwent reduction were more likely to have all fetuses intended to survive living at 1 week postpartum than women with an ongoing triplet pregnancy (RR 1.3, CI 0.72-2.3).

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