The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation

Lidewij Van De Mheen, Sheila M P Everwijn, Maarten F C M Knapen, Dick Oepkes, Melanie Engels, Gwendolyn T R Manten, Hans Zondervan, Soetinah A M Wirjosoekarto, John M G Van Vugt, Jan Jaap H M Erwich, Sebastiaan W A Nij Bijvank, Anita Ravelli, Steffie Heemelaar, Maria G. Van Pampus, Christianne J M De Groot, Ben W J Mol, Eva Pajkrt

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. Study Design This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. Results We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P <.001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins. Conclusion In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.

LanguageEnglish
Pages536.e1-536.e6
JournalAmerican journal of obstetrics and gynecology
Volume211
Issue number5
DOIs
Publication statusPublished - 1 Nov 2014

Keywords

  • multifetal pregnancy reduction
  • multiple pregnancy
  • pregnancy outcome

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Van De Mheen, L., Everwijn, S. M. P., Knapen, M. F. C. M., Oepkes, D., Engels, M., Manten, G. T. R., ... Pajkrt, E. (2014). The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. American journal of obstetrics and gynecology, 211(5), 536.e1-536.e6. https://doi.org/10.1016/j.ajog.2014.04.023
Van De Mheen, Lidewij ; Everwijn, Sheila M P ; Knapen, Maarten F C M ; Oepkes, Dick ; Engels, Melanie ; Manten, Gwendolyn T R ; Zondervan, Hans ; Wirjosoekarto, Soetinah A M ; Van Vugt, John M G ; Erwich, Jan Jaap H M ; Nij Bijvank, Sebastiaan W A ; Ravelli, Anita ; Heemelaar, Steffie ; Van Pampus, Maria G. ; De Groot, Christianne J M ; Mol, Ben W J ; Pajkrt, Eva. / The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. In: American journal of obstetrics and gynecology. 2014 ; Vol. 211, No. 5. pp. 536.e1-536.e6.
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title = "The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation",
abstract = "Objective The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. Study Design This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. Results We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P <.001). The total number of surviving children in the reduced group was 155 (90{\%}) vs 114 (86{\%}) in the ongoing triplet group. After reduction, 75 of women (87{\%}) had all their fetuses surviving, compared with 36 (82{\%}) (relative risk [RR], 1.3; 95{\%} confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93{\%}) (RR, 0.91; 95{\%} CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7{\%}) after reduction vs 5 (11.4{\%}) (RR, 0.81; 95{\%} CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9{\%}) (RR, 1.7; 95{\%} CI, 0.8-3.7) in women with primary twins. Conclusion In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.",
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Van De Mheen, L, Everwijn, SMP, Knapen, MFCM, Oepkes, D, Engels, M, Manten, GTR, Zondervan, H, Wirjosoekarto, SAM, Van Vugt, JMG, Erwich, JJHM, Nij Bijvank, SWA, Ravelli, A, Heemelaar, S, Van Pampus, MG, De Groot, CJM, Mol, BWJ & Pajkrt, E 2014, 'The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation', American journal of obstetrics and gynecology, vol. 211, no. 5, pp. 536.e1-536.e6. https://doi.org/10.1016/j.ajog.2014.04.023

The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. / Van De Mheen, Lidewij; Everwijn, Sheila M P; Knapen, Maarten F C M; Oepkes, Dick; Engels, Melanie; Manten, Gwendolyn T R; Zondervan, Hans; Wirjosoekarto, Soetinah A M; Van Vugt, John M G; Erwich, Jan Jaap H M; Nij Bijvank, Sebastiaan W A; Ravelli, Anita; Heemelaar, Steffie; Van Pampus, Maria G.; De Groot, Christianne J M; Mol, Ben W J; Pajkrt, Eva.

In: American journal of obstetrics and gynecology, Vol. 211, No. 5, 01.11.2014, p. 536.e1-536.e6.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation

AU - Van De Mheen, Lidewij

AU - Everwijn, Sheila M P

AU - Knapen, Maarten F C M

AU - Oepkes, Dick

AU - Engels, Melanie

AU - Manten, Gwendolyn T R

AU - Zondervan, Hans

AU - Wirjosoekarto, Soetinah A M

AU - Van Vugt, John M G

AU - Erwich, Jan Jaap H M

AU - Nij Bijvank, Sebastiaan W A

AU - Ravelli, Anita

AU - Heemelaar, Steffie

AU - Van Pampus, Maria G.

AU - De Groot, Christianne J M

AU - Mol, Ben W J

AU - Pajkrt, Eva

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Objective The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. Study Design This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. Results We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P <.001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins. Conclusion In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.

AB - Objective The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. Study Design This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. Results We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P <.001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins. Conclusion In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.

KW - multifetal pregnancy reduction

KW - multiple pregnancy

KW - pregnancy outcome

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DO - 10.1016/j.ajog.2014.04.023

M3 - Article

VL - 211

SP - 536.e1-536.e6

JO - American journal of obstetrics and gynecology

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Van De Mheen L, Everwijn SMP, Knapen MFCM, Oepkes D, Engels M, Manten GTR et al. The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. American journal of obstetrics and gynecology. 2014 Nov 1;211(5):536.e1-536.e6. https://doi.org/10.1016/j.ajog.2014.04.023