Short-term and long-term outcomes of expectant management compared to
embryo reduction to a twin pregnancy in women with triplet pregnancy: a
retrospective cohort study
Abstract
Objective: To compare maternal, perinatal and long-term outcome of
triplet pregnancies managed expectantly with those reduced to twins
Design: A retrospective cohort study Setting: Tertiary medical
institutions in South Korea Population: We examined short-term and
long-term outcomes in 524 triplet pregnancies with three live fetuses
before 14 weeks of gestation that were comprised of expectant
management(EM) group (n=213) and embryo reduction(ER) group (n=311) from
2006 to 2017. Methods: The two groups were compared for the following
outcomes. Main Outcome Measures: 1) the rates of non-viable pregnancy
loss before 23 weeks, 2) the rates of preterm birth before 32 weeks of
gestation; 3) the number of survival fetuses; and 4) long term
neurodevelopmental outcomes. Results: In the EM group, the risk of
preterm delivery (<36, <34, <32, and
<28 weeks) was higher compared to the ER group. However, the
risk of non-viable pregnancy loss was lower [2(0.9%) vs. 20(6.4%),
p=0.008] in EM group, and the rate of cases with at least one alive
neonate were higher in EM group than ER group [208(97.7%) vs.
287(92.3), p=0.013]. The survival rate until discharge of neonates
were also significantly higher in the EM group than the ER group
[607(95.0%) vs. 545(87.6), p=0.001]. The risk of developmental
delay or cerebral palsy in survived neonates was not different between
the two groups of cases. Conclusions: In triplet pregnancies, EM may
improve the chance of fetal survival, without any significant
differences in developmental delay and cerebral palsy.