Multifetal pregnancy reductions of triplets to twins: Comparison with nonreduced triplets and twins

OBJECTIVE: Multifetal pregnancy reduction has been shown to improve surviva l rates in high-order multifetal pregnancies (greater than or equal to 4). There is, however, some controversy as to whether multifetal pregnancy redu ction improves pregnancy outcomes of triplets reduced to twins. The purpose of this study was to evaluate this issue by comparing outcomes of triplet gestations undergoing reduction to twins with outcomes of nonreduced twin g estations and expectantly managed triplet gestations. STUDY DESIGN: The study included 143 triplet pregnancies that underwent red uction to twins over a 10-year period at a single center. These were compar ed with 12 nonreduced triplet pregnancies from the Wayne State University P erinatal Database and with 2 groups of twin pregnancies: 605 from the Wayne State University Perinatal Database and 207 from the Quest Diagnostics Dat abase. RESULTS: The miscarriage rate for expectantly managed triplets was 25%, com pared with 6.2% for triplets reduced to twins. This rate was similar to the rates for both groups of nonreduced twins: 5.8% (Quest) and 6.3% (Wayne St ate University). Severe prematurity occurred in 25% of nonreduced triplets compared with 4.9% of twins after reduction. This rate was also similar to that of nonreduced twins: 7.7% (Quest) and 8.4% (Wayne Stale University). T he mean gestational age at delivery for expectantly managed triplets (32.9 +/- 4.7 weeks) was significantly shorter than for triplets reduced to twins (35.6 +/- 3.1 weeks). By comparison, nonreduced twins had a mean gestation al age at delivery of 35.8 +/- 3.9 weeks for Quest and 34.4 +/- 3.6 weeks f or Wayne State University Mean birth weights were significantly lower in ex pectantly managed triplets as compared with triplets undergoing reduction t o twins (1636 +/- 645 g vs 2381 +/- 602 g, respectively). Nonreduced twins had a mean birth weight of 2254 +/- 653 g for Quest and 2123 +/- 634 g for Wayne State University. Pregnancy loss rates, mean length of gestation, and mean birth weight did not vary significantly between triplets who underwen t reduction to twins and nonreduced twins. CONCLUSIONS: Reduction of triplets to twins significantly reduces the risk for prematurity and low birth weight and may also be associated with a redu ction in overall pregnancy loss. This suggests that multifetal pregnancy re duction of triplets to twins is a medically justifiable procedure not only from an actuarial viewpoint but also from the ethical perspective of suppor ting patients' autonomy and respect for patients' Individual circumstances. (Am J Obstet Gynecol 1999;180:1268-71.).