Early fetal reduction of dichorionic triplets to dichorionic twin or singleton pregnancies: a retrospective study

Abstract

A retrospective study conducted in an academic reproductive medicine centre evaluated the feasibility and safety of early fetal reduction in dichorionic triplets to dichorionic twin or singleton pregnancies. Thirty-three dichorionic triplets that underwent early transvaginal fetal reduction mechanically between 2002 and 2013 were included, of which 21 patients underwent fetal reduction to dichorionic twins (Group A) and 12 patients underwent fetal reduction to a singleton pregnancy (Group B). A further 84 patients with trichorionic triplets reduced to twins were included as the control group (Group C). The main outcome measures were live birth and preterm labour rates. Both early and late spontaneous abortion rates, were similar in group A compared with groups B and C. Gestational age at delivery was significantly lower in group C versus group A (P = 0.02). The preterm labour rate in group A, which was comparable with that in group C, was greater than in group B, but not significantly. Neonatal birth weight, low birth weight rate and neonatal body height were similar among groups. Small for gestational age rates were comparable. Live birth rates were similar among the groups. Early transvaginal fetal reduction for dichorionic triplets to dichorionic twins may be feasible and safe.

Is it worth reducing twins to singletons after IVF‐ET? A retrospective cohort study using propensity score matching

“…The procedure is easy and quick, lasting an average of 3-5 minutes and so gives maximum avoidance of adverse effects on the remaining fetus. 12,13 With experience of more than 2000 cases of multifetal reduction in our center, the pregnancy loss rate (8-24 weeks) was around 6%, which is comparable to other reports. Furthermore, only two women (2.8%) in the reduced group lost their remaining fetuses at 11 and 12 weeks, respectively, and our records showed that the remaining fetal heartbeats were still normal at 10 weeks of gestation.…”

“…Although there is a small chance of spontaneous fetal losses between 9 and 10 weeks of gestation, it is still reasonable to perform fetal reduction as early as 7‐8 weeks of gestation. The procedure is easy and quick, lasting an average of 3‐5 minutes and so gives maximum avoidance of adverse effects on the remaining fetus . With experience of more than 2000 cases of multifetal reduction in our center, the pregnancy loss rate (8‐24 weeks) was around 6%, which is comparable to other reports.…”

“…The most accessible gestational sac was chosen, and the fetal heart was visualized and aligned with the puncture guideline on the screen. A detailed description of the procedure was reported previously . Briefly, a 17‐gauge needle was used for the puncture.…”

“…A detailed description of the procedure was reported previously. 12,13 Briefly, a 17-gauge needle was used for the puncture. After confirming that the needle had punctured the embryo, vacuum aspiration was performed with a negative pressure of 40 KPa at the beginning, and up to 70-80 KPa when necessary.…”

Pregnancy outcomes of dichorionic triamniotic triplet pregnancies after in vitro fertilization-embryo transfer : multifoetal pregnancy reduction versus expectant management

“…Reduction by the injection technique is not appropriate in women with a MC twin pregnancy because of inter-twin placental vascular anastomoses. In addition, acute haemorrhage of the surviving twin may occur soon after the death of the co-twin through placental vascular anastomoses, with consequent death or neurodevelopmental impairment [34,35]. Relatively new vascular occlusive techniques have enabled the possibility of reducing a triplet pregnancy containing MC twins to a DC twin pregnancy [3,36,37].…”