Multifetal Pregnancy Reduction

Običan, Sarah; Brock, Clifton O.; Berkowitz, Richard L.; Wapner, Ronald J.

doi:10.1097/grf.0000000000000119

Cited by 18 publications

(9 citation statements)

References 52 publications

(54 reference statements)

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“…Mean gestational age and birth weight were significantly lower in twin and triplet births than those in singleton births. Previously, mean gestational age in triplet births in other studies was reported as approximately 33.5 weeks, approximately 25% deliver at <32 weeks and 10% deliver < 28 weeks [ 10 ]. However, those other studies were performed before 2000 year.…”

Section: Discussionmentioning

confidence: 99%

Multiple birth rates of Korea and fetal/neonatal/infant mortality in multiple gestation

Wie

Choi

et al. 2018

PLoS ONE

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ObjectiveThis study was conducted to analyze recent trends of multiple birth rates (MBR) and fetal/neonatal/infant mortalities according to the number of gestations in Korea.MethodsData from 2009 to 2015 of live births, infant deaths and stillbirths were obtained from the Korean Vital Statistics. Neonatal mortality rate (NMR), infant mortality rate (IMR), and fetal mortality rate (FMR) in singleton, twin and triplet pregnancies were analyzed according to gestational period (GP; ≤ 23, 24–27, 28–31, and 32–36 weeks).ResultsFrom 2009 to 2015, twin and triplet birth rates increased 34.5% and 154.3%, respectively. In twin births, NMR and FMR have been decreased significantly (from 10.92 to 8.62, p = 0.034 and from 41.00 to 30.55, p< 0.001, respectively), but IMR did not show significant decrease. There was no significant change of NMR, IMR, and FMR, in triplet births. Overall, in singleton, twin, and triplet births, NMR was 1.26 ± 0.09, 10.6 ± 1.12, and 34.32 ± 11.72, respectively, and IMR was 2.38 ± 0.26, 14.52 ± 1.38, and 41.13 ± 12.2, respectively. FMRs were 12 ± 1.73, 35.99 ± 3.55, and 88.85 ± 16.55, respectively, in singleton, twin, and triplet pregnancies. In spite of decreasing trends in overall mortalities, the odds ratios of NMRs and IMRs in 2015 were approximately 9-fold and 6-fold higher, respectively, in twin births, and approximately 37-fold and 20-fold higher, respectively, in triplet births, than those in singleton births. There were no significant differences in odds ratios of NMRs and IMRs at GP 32–36 among single, twin, and triplet births, although the odds ratios of FMR at GP 32–36 in triplet gestation was significantly higher than those in singleton and twin gestation.ConclusionNeonatal/infant mortality in multiple births is still significantly high, which is mainly related with preterm birth. Close fetal monitoring is needed to prevent fetal death in triplet pregnancies, after 32 gestational weeks.

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Section: Discussionmentioning

confidence: 99%

Multiple birth rates of Korea and fetal/neonatal/infant mortality in multiple gestation

Wie

Choi

et al. 2018

PLoS ONE

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“…This should be interpreted with caution because neonatal survival has improved in the last decade as the result of advances in neonatal intensive care. A review by Običan et al 17 concluded that MFPR to twins increases gestational age at delivery by 4 weeks and significantly improves maternal and fetal outcomes. In the study by Chaveeva et al, 13 preterm birth before 33 weeks was reduced to 13.1% compared with 35.1% in expectantly managed TCTA triplets.…”

Section: Discussionmentioning

confidence: 99%

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

Singh

Thakur

Shahnaz

et al. 2021

Intl J Gynecology & Obste

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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.

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“…Multiple studies have demonstrated that gestational age of delivery for twins after MFPR was significantly higher than that of trichorionic triplets (35-36 vs. 32-33 weeks). 14,[19][20][21] The average gestational ages at delivery in our population were similar (33 weeks for TT vs. 34 weeks for MFPR). Moreover, in contrast to previous studies, we found that rates of preterm delivery did not differ between TT and MFPR at any gestational age between 24 and 34 weeks.…”

Section: Commentmentioning

confidence: 99%

Multifetal Pregnancy Reduction of Trichorionic Triplet Gestations: What is the Benefit?

et al. 2017

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Objective This study aims to determine the efficacy of multifetal pregnancy reduction (MFPR) in improving obstetrical outcomes for trichorionic triplet gestations. Study Design Retrospective cohort study of patients with multiple gestations delivered by a single maternal-fetal medicine practice from 2005 to 2016. We compared patients with trichorionic triamniotic triplet gestations who underwent MFPR to those with an ongoing triplet pregnancy (TT), as well as primary dichorionic diamniotic twin gestations (DD). Logistic regression analysis was used to control for any differences at baseline. Results There were 42 patients in the MFPR group, 43 women in the TT group, and 693 women in the DD group. Comparing MFPR to TT, the likelihood of preterm birth < 34 weeks was similar (31.0 vs. 39.5%, adjusted odds ratio [aOR]: 0.63, 95% confidence interval [CI]: 0.21, 1.87). There were no differences in gestational age at delivery, pregnancy loss < 24 weeks, or the likelihood of all, none, or at least two babies surviving to discharge. Mean birth weights were significantly higher and cesarean delivery rates lower for MFPR (2,128 vs. 1,836 g, p = 0.028 and 69 vs. 86%, aOR: 0.25, 95% CI: 0.06, 0.94) as compared with the TT group. MFPR had significantly worse outcomes than DD. Conclusion In trichorionic triamniotic triplet pregnancies, our study suggests that obstetrical outcomes may not be as dramatically improved with MFPR as seen in older studies.

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Multifetal Pregnancy Reduction

Cited by 18 publications

References 52 publications

Multiple birth rates of Korea and fetal/neonatal/infant mortality in multiple gestation

Multiple birth rates of Korea and fetal/neonatal/infant mortality in multiple gestation

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

Multifetal Pregnancy Reduction of Trichorionic Triplet Gestations: What is the Benefit?

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