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

Chaveeva, Petya; Kosinski, Przemek; Puglia, Danila; Poon, Liona C.; Nicolaides, Kypros H.

doi:10.1159/000356170

Cited by 65 publications

(76 citation statements)

References 12 publications

(17 reference statements)

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“…However, in the triplet pregnancies, a very high proportion of survivors, about 60%, were born at <32 weeks' gestation. We have previously reported that in trichorionic triplet pregnancies with three live fetuses at 10-14 weeks' gestation that were managed expectantly, 35% delivered at <33 weeks; the rate in DC triplet pregnancies managed expectantly was 46% [27] . The higher rate of preterm birth in DC triplets complicated by severe FFTS and treated by endoscopic laser surgery is not surprising.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

Peeva

Chaveeva²,

Guevara³

et al. 2016

Fetal Diagn Ther

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Objective: To report the outcome of monochorionic (MC) and dichorionic (DC) triamniotic (TA) triplet pregnancies treated with endoscopic laser coagulation of the communicating placental vessels for severe feto-fetal transfusion syndrome (FFTS) and selective fetal growth restriction (sFGR). Methods: Laser surgery was performed at 18 (15-24) weeks' gestation in 11 MCTA and 33 DCTA pregnancies complicated by FFTS and 14 DCTA pregnancies complicated by sFGR. Data from our study and previous reports were pooled using meta-analytic techniques. Results: Survival of at least one baby and survival among all fetuses was 97.0 and 72.7% in DCTA pregnancies with FFTS, 78.6 and 52.4% in DCTA pregnancies with sFGR and 81.8 and 39.4% in MCTA pregnancies with FFTS. In the combined data from our study and previous reports, the pooled survival rates in 132 DCTA pregnancies with FFTS were 94.4 and 76.1%, and in 29 MCTA pregnancies with FFTS, they were 80.6 and 57.5%. Conclusions: Survival after laser surgery is higher in DC triplets with FFTS than in those with sFGR and in DC than in MC triplets with FFTS.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

Peeva

Chaveeva²,

Guevara³

et al. 2016

Fetal Diagn Ther

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Section: Discussionmentioning

confidence: 99%

“…Although the number of cases presented in this study is too small for definite conclusions to be drawn, it appears that ER to dichorionic twins by intrafetal laser may be associated with a better outcome than with alternative management options [1]. We have recently reported that in DCT pregnancies expectant management is associated with high rates of both miscarriage (8%) and early preterm birth (46%), which could, at least in part, be attributed to complications arising from intertwin placental vascular communications and/or unequal sharing of the placenta in the monochorionic pair [1,9]. The option of ER of the separate fetus by intracardiac injection of KCl is associated with halving of the rate of preterm birth to 23%, but an increase in the rate of miscarriage to 13% because the complications of monochorionic twins persist with the addition of complications arising from the intra-uterine presence of dead fetoplacental tissue [1,9,10].…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study we reported the outcome of 528 trichorionic triplet pregnancies and 167 DCT pregnancies managed expectantly or by fetal intracardiac injection of KCl for ER to twins or singletons [1]. In this study we present the technique and outcome of 22 DCT pregnancies undergoing ultrasound-guided laser ablation of the pelvic vessels of one of the monochorionic twins.…”

Section: Methodsmentioning

confidence: 99%

“…In triplet pregnancies diagnosed during the first trimester management options include continuing with the whole pregnancy or embryo reduction (ER) to twins or singletons by fetal intracardiac injection of potassium chloride (KCl) [1]. In dichorionic triplet (DCT) pregnancies, ER involves either the dichorionic fetus or both monochorionic twins.…”

Section: Introductionmentioning

confidence: 99%

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Embryo Reduction in Dichorionic Triplets to Dichorionic Twins by Intrafetal Laser

Chaveeva

Kosinski²,

Birdir

et al. 2013

Fetal Diagn Ther

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Objective: To describe a new technique for embryo reduction (ER) in dichorionic triplet (DCT) pregnancies. Methods: In 22 DCT pregnancies, ER to dichorionic twins was carried out at 11.3-13.9 weeks' gestation by ultrasound-guided laser ablation of the pelvic vessels of one of the monochorionic twins. Results: Intrafetal laser was successfully carried out in all cases, but ultrasound examination within 2 weeks of the procedure demonstrated that the co-twin had died in 11 cases and was alive in the other 11. In the dichorionic group there was one miscarriage at 23 weeks due to cervical incompetence and in the other 10 cases there were two live births at a median gestational age of 35.0 (range 32.2-37.1) weeks. In the 11 cases where both monochorionic fetuses died the separate triplet was live born at a median gestation of 38.0 (range 32.2-40.5) weeks. Conclusions: In the management of DCT pregnancies, ER to dichorionic twins by intrafetal laser is an additional option to the traditional ones of expectant management, ER by intrafetal injection of potassium chloride (KCl) to monochorionic twins or ER by KCl to singleton.

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

Cited by 65 publications

References 12 publications

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

Embryo Reduction in Dichorionic Triplets to Dichorionic Twins by Intrafetal Laser

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

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