A comparative study of multifetal pregnancy reduction from triplets to twins in the first versus early second trimesters after detailed fetal screening

Objectives To compare the outcome of multifetal pregnancy reduction from tr iplets to twins performed either early (at 11-12 weeks' gestation) or late (at 13-14 weeks). Methods Ninety-five high-order pregnancies following assisted conception we re studied. Transabdominal sonographically guided multifetal pregnancy redu ction was performed early in 46 women, while 49 women first underwent a son ographic fetal anomaly scan before undergoing selective reduction. Results Sonographic screening led to selective termination of a specific fe tus in nine cases due to increased nuchal translucency and relative intraut erine growth restriction in three cases each, and meningomyelocele, abdomin al cyst and cystic hygroma in one case each. In the early reduction group a diagnosis of hypoplastic left heart in the two remaining twins was subsequ ently made, and one pair of twins suffers from cerebral palsy. The rate of pregnancy loss was not statistically different between the early (4.3%; 2/4 6) and late (4.0%; 2/49) termination groups. The birth weight and gestation al age at birth were not statistically different between the early (n = 85) and late (n = 94) groups (2110 +/- 580 vs. 2140 +/- 490 g, and 35.8 +/- 3. 0 vs. 35.7 +/- 3.5 weeks). Similarly there was no statistically, significan t difference between early, and late groups in the incidence of very premat ure (24-32 weeks; 9.3 vs. 8.3%) and premature (33-36 weeks; 46.5 vs. 47.9%) births. Conclusions Early, second-trimester multi fetal pregnancy, reduction from t riplets to twins may allow more selective termination of abnormal fetuses w ithout an adverse effect on the outcome of pregnancy. However, further stud ies are needed in order to confirm our observations in a larger series.