Multifetal reduction of triplets to twins improves perinatal outcome

Cervical length, multifetal pregnancy reduction, and prediction of preterm birth

“…2 Nevertheless, in spite of the contribution of multifetal pregnancy reduction, a considerable proportion of multifetal births still occur before 34 weeks' gestation. [3][4][5][6][7][8] Transvaginal sonography for measuring cervical length has been proposed as a means for providing valuable information in the prenatal care of singleton, 9 twin, 10-14 and triplet gestations. [15][16][17][18] The objective of this study was to evaluate the role of sonographic assessment of cervical length before fetal reduction in predicting spontaneous preterm birth in triplet gestations reduced to twins.…”

Outcomes of Multifetal Pregnancy Reduction in Multiple Pregnancies Achieved by Intracytoplasmic Sperm Injection Using Ejaculated, Testicular, or Epididymal Sperm

“…However, approximately 40% of the reduction procedures reported in the literature were performed on triplets, with a range of 5-44% [4,11,14,15,17], While the reported rate of spontaneous triplets is 1 in 8,000 births, its incidence has reached a high frequency with the increasing use of ovula tion-inducing agents and assisted reproductive techniques [1,3,18], French in vitro fertilization centers national data showed a triplet incidence of 3.2% over 4 years [ 19], Some authors have reported that the outcome of triplet pregnancies may be satisfactory without any intervention [20], On the other hand, many studies dealing with triplet gestations show a high rate of miscarriages and preterm deliveries, an increased rate of small-for-gestational age fetuses, a high rate of perinatal mortality, and a consider ably high rate of resultant morbidity [2][3][4]18]. Severe and life-threatening maternal complications have also been reported in triplet pregnancies [4], Macones et al [9] compared the perinatal outcome of triplet pregnancies reduced to twins with the outcomes of continuing triplet pregnancies and natural twin pregnan cies. There was no difference among the groups with regard to the development of maternal complications; however, the reduced group had a 4.4-week improvement in mean gestational age at delivery and a 685-gram increase in mean birth weight as compared with the nonreduced triplets.…”

“…Collaborative data obtained from the world's largest centers and individual reports on MFPR have been pub lished recently [3,4,[6][7][8][9][10][11][12][13][14][15][16][17], The procedure is technically successful in nearly 100% of the cases. The risk of an early loss (<4 weeks) is about 4-6%, and the rate of complete miscarriage before 24 weeks is between 0 and 31%.…”

“…However, the perinatal and maternal outcomes of these pregnancies are generally poor [2,3,5], Therefore, until advances in reproductive technologies eliminate the iatrogenic occurrence of multi fetal gestation, MFPR offers an acceptable option to improve the outcome of such pregnancies [3,4,[6][7][8][9][10][11][12][13][14][15][16]. Although various techniques have been used for MFPR, the lst-trimester transabdominal intrathoracic injection of potassium chloride under ultrasound guidance is cur rently the most accepted technique [3,4,7,10], As spon taneous fetal loss has been reported to occur frequently in multiple pregnancies and since its occurrence is much more likely before 10 weeks' gestation, performing the reduction after 10 weeks is better, and the transabdominal route is also safer at this time [3,4,16].…”

First-Trimester Multifetal Pregnancy Reduction: Evaluation of Technical Aspects and Risks from 2,756 Cases in the Literature

“…Many studies have demonstrated that first-trimester multifetal pregnancy reduction improves pregnancy outcome [31]. It reduces prematurity, improves fetal growth and avoids maternal complications [4].…”