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27: Outcome after embryo reduction in triplet pregnancy compared to ongoing triplet pregnancies and primary twins

      Objective

      To assess in triplet pregnancies the effectiveness of selective reduction to twins.

      Study Design

      We studied in a retrospective study consecutive cases of triplet pregnancies that were reduced to twins in all fetal medicine units in the Netherlands (2000-2010). All reductions were performed for social indication, transabdominally by intracardiac KCl injection between 10-15 weeks. The outcome was compared to ongoing triplet pregnancies retrieved from the Dutch Perinatal Registration (PRN), and to twin pregnancies collected from a previous RCT comparing progesterone to placebo (AMPHIA ISRCTN 40512715). The three groups were compared for mean gestation age, pregnancy loss <24 weeks, delivery <32 weeks, neonatal birth weight and number of stillbirths. Statistical test were performed in SPSS 18. One Way ANOVA test was use to compare mean gestational age and Chi Square test to compare delivery <24 and <32 weeks, neonatal birth weight and number of stillbirths.

      Results

      We identified 76 triplet pregnancies reduced to twins. Mean gestational age at delivery was 33.7 weeks (SD 5.5). For ongoing triplets and primary twins this was 32.8 weeks (SD 3.8) and 35.6 weeks (SD 3.7), resp. Mean neonatal birth weight of the first child was 2123.5 grams (SD 811.6) in the reduced group, 1883.2 (703.8) and 2383.7 (657.7) grams in ongoing triplets and primary twins, resp. Preterm delivery < 24 and < 32 weeks was not different for ongoing triplets and triplets reduced to twins (3.8% vs 7.9% and 26.8% vs 22.4% resp.) but there was a significant difference between the reduction group and primary twins for delivery <24 and <32 weeks (7.9% vs 2.6% and 22.4% vs 11.1 % resp.). In the reduction group there were 9 stillbirths (16%), for ongoing triplets and primary twins this was significantly lower, 22 (4%) and 15 (2%) resp.

      Conclusion

      Embryo reduction from triplet to twin did not improve gestational age and neonatal outcome and these twins are not comparable to primary twins. Since the risk of pregnancy loss <24 weeks increases in reduced twins, improvement in obstetric outcome should not be used as an argument for reduction.
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