A PROSPECTIVE COMPARISON OF THE OUTCOME OF TRIPLET PREGNANCIES MANAGED EXPECTANTLY OR BY MULTIFETAL REDUCTION TO TWINS

OBJECTIVE: Our aim was to compare the outcome of triplet pregnancies m anaged expectantly or by multifetal reduction to twins. STUDY DESIGN: From January 1984 through January 1992, 140 triplet gestations were di agnosed before the ninth gestational week, Multifetal pregnancy reduct ion was performed at the patient's request in 34 women. The remaining 106 triplet pregnancies were managed expectantly. All patients were pr ospectively followed up and delivered in a single perinatal department . RESULTS: Loss of the entire pregnancy before 25 gestational weeks oc curred in 20.7% of the triplet pregnancies managed expectantly as comp ared with 8.7% in the group with reduction to twins. A successful preg nancy as defined by the discharge home of at least one infant occurred in 88.2% of the group with reduction to twins and 74.5% of the triple ts managed expectantly. Fetal reduction to twins was associated with a significantly lower incidence of the following: prematurity (p < 0.00 1), low-birth-weight infants (p < 0.001), and very-low-birth-weight in fants (p < 0.001). Pregnancy complications and neonatal morbidity and mortality were less in the group with reduction to twins. CONCLUSIONS: Multifetal pregnancy reduction of triplet pregnancies to twins result ed in improved pregnancy outcome without an excess loss of the entire pregnancy as compared with the outcome of triplet gestations managed e xpectantly.