Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review

Papageorghiou, Aris T.; Avgidou, K.; Bakoulas, V.; Sebire, Neil J.; Nicolaides, Kypros H.

doi:10.1093/humrep/del048

Cited by 103 publications

(92 citation statements)

References 31 publications

(48 reference statements)

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“…In a previous study of trichorionic triplet (TCT) pregnancies with 3 live fetuses at 10-14 weeks' gestation, including 185 that were managed expectantly and 180 that had embryo reduction (ER) to twins, we found that ER was associated with an increase in the rate of miscarriage but a decrease in early preterm birth [1,2,3]. …”

Section: Introductionmentioning

confidence: 99%

Trichorionic and Dichorionic Triplet Pregnancies at 10-14 Weeks: Outcome after Embryo Reduction Compared to Expectant Management

et al. 2013

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Objective: To compare the outcome of trichorionic triplet (TCT) and dichorionic triplet (DCT) pregnancies managed expectantly and those with embryo reduction (ER) at 10-14 weeks to twins or singletons. Methods: This was a retrospective study of triplet pregnancies with 3 live fetuses managed expectantly or by ER. Data were combined with the results of previous studies that used similar entry criteria and outcome measures. The management options were compared for rates of miscarriage and preterm birth <33 weeks. Results: In TCTs managed expectantly (n = 358), the rates of miscarriage and preterm birth were 3.1 and 35.1%. Compared to the expectantly managed TCTs, the rate of miscarriage was higher and preterm birth lower in TCTs with ER to 2 fetuses (n = 833, 7.3 and 13.1%, respectively) and TCTs with ER to 1 fetus (n = 78, 11.5 and 8.7%). In DCTs managed expectantly (n = 136), the rates of miscarriage and preterm birth were 8.8 and 46.0%. In DCTs with ER to 2 fetuses (n = 15) or ER to 1 fetus (n = 42), there was a non-significant increase in miscarriage (13.3 and 16.7%, respectively) and decrease in preterm birth (23.1 and 8%, respectively). Conclusions: In TCT and DCT pregnancies, ER increases the rate of miscarriage but reduces the rate of preterm birth.

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Section: Introductionmentioning

confidence: 99%

Trichorionic and Dichorionic Triplet Pregnancies at 10-14 Weeks: Outcome after Embryo Reduction Compared to Expectant Management

et al. 2013

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“…This constellation is found in approximately one-fourth of our triplet and quadruplet population at 11-14 weeks. Previous studies reported between 11 and 24 % of triplets containing monochorionic placentas [10,11]. The prevalence of monochorionic pairs in spontaneously conceived triplets is between 40 and 50 % [9], while it is only 5-10 % after assisted conception [5].…”

Section: Discussionmentioning

confidence: 90%

“…Management options and survival of triplets are frequently discussed [2,11,12]. It is generally accepted that selective reduction in higher-order multiples has a positive impact on gestational length but may increase the risk of miscarriage [13].…”

Section: Introductionmentioning

confidence: 99%

Expectant management versus multifetal pregnancy reduction in higher order multiple pregnancies containing a monochorionic pair and a review of the literature

Abel

Flöck

Berg

et al. 2016

Arch Gynecol Obstet

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“…Selective embryo reduction in the first trimester also improves perinatal outcomes in triplets [20,21] , decreasing rates of preterm delivery before 32 weeks (RR = 0.37, 95% CI = 0.27-0.51) [21] . On the other hand, embryo reduction is associated with an increased risk of miscarriage (RR = 1.83, 95% CI = 1.08-3.16) [21] .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, embryo reduction is associated with an increased risk of miscarriage (RR = 1.83, 95% CI = 1.08-3.16) [21] . Currently, there is not enough evidence to recommend embryo reduction because of the lack of randomized trials [22] .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Triplet Pregnancy Complicated by Uterus Didelphys: A Case Report

et al. 2010

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Uterine malformations and spontaneous triplet pregnancy are rare situations separately, and both are related to worse perinatal outcomes. In the 3 cases of combined triplet pregnancy and uterus didelphys previously published, at least 2 of the 3 fetuses died. Morbidity rates are also high. We report the case of a 24-year-old Caucasian woman with a uterus didelphys and two previous caesarean sections who carried a spontaneous triplet pregnancy. To our knowledge, this is the first case of a spontaneous triplet pregnancy in a uterus didelphys ever reported and the only one with uneventful perinatal outcome for all fetuses. Expectant management may be an alternative to embryo reduction to manage triplet pregnancies in a didelphys uterus, especially when this option is not considered. Nevertheless, there is not enough evidence to confirm which is the optimal management strategy, and more studies are needed.

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Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review

Abstract: In trichorionic triplets, ER to twins is associated with an increase in the risk of subsequent miscarriage and decrease in risk of early preterm birth.

Cited by 103 publications

References 31 publications

Trichorionic and Dichorionic Triplet Pregnancies at 10-14 Weeks: Outcome after Embryo Reduction Compared to Expectant Management

Trichorionic and Dichorionic Triplet Pregnancies at 10-14 Weeks: Outcome after Embryo Reduction Compared to Expectant Management

Expectant management versus multifetal pregnancy reduction in higher order multiple pregnancies containing a monochorionic pair and a review of the literature

Spontaneous Triplet Pregnancy Complicated by Uterus Didelphys: A Case Report

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