Pregnancy and Obstetric Outcomes of Dichorionic and Trichorionic Triamniotic Triplet Pregnancy with Multifetal Pregnancy Reduction: A Retrospective Analysis Study

Abstract

Background: It is generally beneficial for triplet gestation or high-order multiple pregnancies to operate multifetal pregnancy reduction (MFPR) after assisted reproductive techniques. However, data on pregnancy outcomes is lacking regarding dichorionic triamniotic (DCTA) and trichorionic triplets (TCTA) pregnancy.Method: This research analyzes the difference between 128 DCTA and 179 TCTA pregnancies with or without MFPR after in vitro fertilization/intracytoplasmic sperm injection cycles between January 2015 and June 2020. The subdivided subgroups of the two groups are reduction to singleton, reduction to dichorionic twins, and anticipation management groups. We also compare the pregnancy and obstetric outcomes between 2104 dichorionic twins and 122 monochorionic twins.Result: The research subgroups were DCTA to monochorionic singleton pregnancies (n=76), DCTA to dichorionic twin pregnancies (n=18), DCTA-anticipation management (n=34), TCTA to monochorionic singleton pregnancies (n=31), TCTA to dichorionic twin pregnancies (n=130), and TCTA-anticipation management (n=18). In DCTA-anticipation management group, the complete miscarriage rate is dramatically higher, and the survival rate and the rate of take-home babies are lower. However, there was no difference between the rates of complete miscarriages, survival rates, and take-home babies in TCTA-anticipation management group. But the complete miscarriage rate of DCTA-anticipation management was obviously higher than that of TCTA-anticipation management group (29.41 vs. 5.56%, p=0.044). For obstetric outcomes, MFPR to singleton group had higher gestational week and average birth weight, but lower premature delivery, gestational hypertension rates and low birth weight in both DCTA and TCTA pregnancy groups (all p<0.05). Monochorionic twins have higher rates of complete, early, and late miscarriage, premature delivery, and late premature delivery, and lower survival rate and twin survival rate rates (p<0.05).Conclusion: MFPR could improve gestational week and average birth weight, reducing premature delivery, LBW, and gestational hypertension rates in DCTA and TCTA pregnancies. Monochorionic twins have worse pregnancy and obstetric outcomes. MFPR to singleton is preferable recommended in the pregnancy and obstetric management of complex triplets with monochorionic pair.