Outcomes of fetal reduction versus expectant management in dichorionic triamniotic triplets

Objective: To compare the outcomes of dichorionic triamniotic (DCTA) triplets who underwent fetal reduction (FR) to singletons or twins with those managed expectantly. Methods: We conducted a retrospective study of DCTA triplets with three living fetuses at 11-14 weeks over a 7-year period. Pregnancy outcomes were compared following different management strategies. Results: Of 108 included patients, 22 underwent expectant management (EM), 28 were reduced to dichorionic diamniotic twins, and 58 to singletons. The median gestational age at birth for EM, FR to twins, and singletons was 33.1 weeks, 37.0 weeks, and 38.6 weeks, respectively (P < 0.001). Prematurity before 37 and 34 weeks was less common following FR to singletons and twins than in ongoing triplets (18.9%, 46.2% and 90.5%, P < 0.001; 13.2%, 26.9% and 57.1%, P < 0.001). Neonatal birth weight was higher in triplets reduced to singletons and twins compared with EM cases (3140g, 2315g, and 1860g, P < 0.001). However, rates of miscarriage, pregnancies with >= 1 survivor, maternal complications, and adverse neonatal outcomes were comparable among the three groups. Conclusions: In our experience, FR in DCTA triplets could reduce prematurity risk compared to EM, but it confers no survival advantage. Fetal reduction to singletons may result in more favorable outcomes than those reduced to dichorionic twins. Key points What is already known about this topic? center dot Options for managing dichorionic triamniotic triplets include expectant management, reduction to monochorionic or dichorionic twins, and reduction to singletons. The optimal management strategy is still under debate. What does this study add? center dot Fetal reduction to singletons or dichorionic twins benefits in reducing prematurity risk compared with ongoing dichorionic triamniotic triplets, whereas the risk of pregnancy loss is comparable. center dot Fetal reduction to singletons leads to a decreased risk of prematurity and higher birth weight than those reduced to dichorionic twins.

Automated summary

This study compared the outcomes of different management strategies for DCTA triplets. It found that fetal reduction to singletons or dichorionic twins can reduce the risk of prematurity compared to ongoing triplets. However, there was no survival advantage with fetal reduction. Additionally, reducing to singletons may result in more favorable outcomes than reducing to dichorionic twins.