Triplets: Outcomes of expectant management versus multifetal reduction for127 pregnancies

OBJECTIVE: Our purpose was to compare outcomes of women with triplet gestat ions conceived via assisted reproductive technology who chose expectant man agement or multifetal pregnancy reduction. STUDY DESIGN: We performed a retrospective review of all women who initiate d assisted reproductive technology cycles from August 1995 through July 199 7 with ultrasonographic documentation of triplets exhibiting fetal heart to nes at 9 weeks of gestation (N = 127). Patients were then uniformly referre d to a maternal-fetal medicine specialist and to 3 centers offering multife tal pregnancy reduction. RESULTS: Thirty-six percent of patients (46/127) chose multifetal pregnancy reduction with 95% undergoing reduction to twins. In the expectant managem ent group, 13.6% of pregnancies were reduced spontaneously after 9 weeks of gestation. The "take home" infant per delivery rates for the multifetal pr egnancy reduction and expectant management groups were 87% and 90.1%, respe ctively (P=.66). The mean gestational ages at delivery (+/-SE) for the mult ifetal pregnancy reduction and expectant management groups were 33.25 +/- 1 .03 weeks and 32.04 +/- 0.58 weeks (P=.23), and the mean birth weights of i nfants delivered at >24 weeks of gestation were 2226 +/- 79 and 1796 +/- 44 , respectively (P<.0001). There were no significant differences in perinata l mortality, gestational age at delivery, or "take home" infant per deliver y rates between these groups. CONCLUSIONS: These data suggest that multifetal pregnancy reduction does no t have a significant impact on the probability of live birth or on gestatio nal age at delivery for women with triplets conceived with assisted reprodu ctive technology.