Clinical outcomes in higher‐order multiples reduced to dichorionic diamniotic (DCDA) twins compared with primary twins and singletons: A prospective observational study

Abstract

Objective: To compare outcomes in higher-order multiple pregnancies reduced to dichorionic diamniotic (DCDA) twins with primary DCDA twins and singleton pregnancies.Methods: This prospective observational study included all higher-order multiple pregnancies that underwent ultrasound-guided transabdominal fetal reduction at 11-13 weeks of gestation from January 2018 to June 2020. Outcomes were compared with 100 primary DCDA twins and 1078 singletons.Results: Sixty-four higher-order multiples underwent reduction at mean gestational age of 11.46 weeks. Of the reduced pregnancies, 3.12% resulted in miscarriage before 24 weeks compared with 2% (2/100) of primary twins and 0.74% of singletons (P = 0.09). The mean gestational age at delivery was 33.48 weeks for reduced twins, 34.52 weeks for primary twins (P = 0.10) and 38.14 weeks for singletons (P < 0.001).Compared with primary twins, the adjusted odds of preterm delivery before 34 weeks and before 36 weeks for reduced twins were 0.56 (95% confidence interval [CI] 0.48-3.54, P = 0.62) and 0.84 (95% CI 0.78-8.85, P = 0.08), respectively. There was no significant difference in rates of pre-eclampsia, Cesarean delivery, birth weight below the 10th and 3rd centiles, and perinatal mortality among primary and reduced twins.All risks were significantly lower in singleton pregnancies. Conclusion:Reduced twins have similar obstetric and perinatal outcomes as primary twins, but adverse outcomes are significantly higher in both groups when compared with singleton pregnancies.

Embryo Reduction to Twins (ERTT) Versus Cerclage in Triplets in Women with Normal Cervical Parameters: A Retrospective Study

“…The concern now worldwide is how to reduce multiple pregnancies rate as the risk of multiple pregnancy outweigh its benefits especially with the high incidence of complications including preterm birth, preeclampsia, Diabetes and placental problems , and the strategies are directed to both primary and secondary prevention [2] .…”

“…Controlling and limiting the number of embryos transferred in ART is the cornerstone in the primary prevention strategies as it lead to prevention of occurrence of multiple pregnancy, even some countries limited embryo transfer to maximum 2 embryos . However, the best practice if to include the couples in decision regarding number of embryos transferred as practiced in USA [2] .…”

The clinical outcomes of selective and spontaneous fetal reduction of twins to a singleton pregnancy in the first trimester: a retrospective study of 10 years

“…Multifetal pregnancy is prevalent in assisted reproduction technology (ART), which can result in a series of complications such as gestational diabetes, hypertensive disorders, premature rupture of membranes, premature birth, etc. [1][2][3][4]. Although the incidence rate of multifetal pregnancy differs among all reproductive centers worldwide, ART has contributed to a substantial proportion of all twins, triplets, and higher-order infants born [5].…”