Lidewij van de Mheen1, Sheila M P Everwijn2, Maarten F C M Knapen3, Dick Oepkes4, Melanie Engels5, Gwendolyn T R Manten6, Hans Zondervan7, Soetinah A M Wirjosoekarto8, John M G van Vugt9, Jan Jaap H M Erwich10, Sebastiaan W A Nij Bijvank11, Anita Ravelli12, Steffie Heemelaar13, Maria G van Pampus14, Christianne J M de Groot5, Ben W J Mol15, Eva Pajkrt2. 1. Departments of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands. Electronic address: lidewijvandemheen@gmail.com. 2. Academic Medical Center, Amsterdam, The Netherlands. 3. Erasmus Medical Center, Rotterdam, The Netherlands. 4. Leiden University Medical Center, Leiden, The Netherlands. 5. Departments of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands. 6. University Medical Center, Utrecht, The Netherlands. 7. Rijnstate Hospital, Arnhem, The Netherlands. 8. Maastricht University Medical Center, Maastricht, The Netherlands. 9. Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 10. University Medical Center, University of Groningen, Groningen, The Netherlands. 11. Isala Clinics, Zwolle, The Netherlands. 12. Department of Epidemiology, Academic Medical Center, Amsterdam, The Netherlands. 13. De Tjongerschans Hospital, Heerenveen, The Netherlands. 14. Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. 15. Robinson Institute, School of Paediactrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
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.
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.
Authors: Zhu Yimin; Tang Minyue; Fu Yanling; Yan Huanmiao; Sun Saijun; Li Qingfang; Hu Xiaoling; Xing Lanfeng Journal: Front Endocrinol (Lausanne) Date: 2022-06-24 Impact factor: 6.055
Authors: C A Combs; E Schuit; S N Caritis; A C Lim; T J Garite; K Maurel; D Rouse; E Thom; A T Tita; Bwj Mol Journal: BJOG Date: 2015-12-10 Impact factor: 6.531