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Multiple pregnancies and fetal reduction
(2)
Title: Multifetal pregnancy reductions of triplets to twins:
Comparison with nonreduced triplets and twins
Author: Y. Yaron, et al.
Address: Detroit, Michigan
Source: American Journal of Obstetrics and Gynecology 180: 1268-1271
(May) 1999
Summary: The purpose of this study was to evaluate outcomes of triplet
gestations undergoing reduction to twins with outcomes of nonreduced twin
gestations and expectantly managed triplet gestations. The study included 143
triplet pregnancies that underwent reduction to twins over a 10-year period at a
single center. These were compared with 12 nonreduced triplet pregnancies and
605 twin pregnancies from the Wayne State Univ. Perinatal Database, and 207 twin
pregnancies from the Quest Diagnostics Database. The miscarriage rate for
expectantly managed triplets was 25%, compared with 6.2% for triplets reduced to
twins. Severe prematurity occurred in 25% of nonreduced triplets, compared with
4.95 of twins after reduction. Both of these rates were similar to those of
nonreduced twins. Mean gestational age at delivery and mean birth weights were
significantly lower for expectantly managed triplets as compared with triplets
undergoing reduction to twins. Pregnancy loss rates, mean length of gestation,
and mean birth weight did not vary significantly between triplets who underwent
reduction to twins and nonreduced twins. It was concluded that reduction of
triplets to twins significantly reduces the risk for prematurity and low birth
weight and may be associated with a reduction in overall pregnancy loss.
Comment: Clearly multiple gestations will always be a part of therapy with
our present fertility promoting technologies. Still, the best method is to avoid
rather than treat multiple gestations. Presently, the two greatest advances that
could be made in the field of reproductive medicine would be to reduce transfer
rate after IVF to no more than two embryos and for insurance companies to
recognize infertility as a disease and cover therapy. The societal and economic
benefit would be enormous.
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