Skip to main content

A comparative study of obstetric outcomes in electively or spontaneously reduced triplet pregnancies

Archives of Gynecology and Obstetrics volume 290, pages 177–184 (2014)Cite this article

Abstract

Purpose

This study aimed at evaluating the pregnancy outcomes of IVF triplets which are spontaneously or electively reduced to twins and to compare them with non-reduced triplets and twins.

Methods

Retrospective analysis of trichorionic triplets and dichorionic twins of IVF pregnancies.

Results

Preeclampsia rate was significantly higher in triplet group (p = 0.014). Premature contractions requiring tocolysis were seen more often in spontaneous reduction and triplet groups compared to elective reduction and twin groups (p < 0.001). Elective reduction and twin groups had significantly lower rate of infants weighing less than 1,500 g than those of triplets (p < 0.001). Highest rate for infants weighing over 2,500 g was found in primary twin group. Preterm delivery rates were significantly lower in both twin and elective reduction groups compared to triplet and spontaneous reduction groups (p < 0.001). Proportion of women giving birth at term was not different in elective reduction and twin groups, and they were significantly higher compared to spontaneous reduction group (p = 0.024). Perinatal mortality rates of both elective reduction and twin groups were significantly less than those in the triplet group (p = 0.045 and p < 0.001, respectively).

Conclusions

Obstetric outcomes of triplets from IVF or ovulation induction cycles undergoing elective reduction are better than ongoing triplet and spontaneous reduction groups and are similar to that of dichorionic twins.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Practice Committee of American Society for Reproductive Medicine (2012) Multiple gestation associated with infertility therapy: an american society for reproductive medicine practice committee opinion. Fertil Steril 97:825–834

    Article  Google Scholar 

  2. Boulot P, Vignal J, Vergnes C, Dechaud H, Faure JM, Hedon B (2000) Multifetal reduction of triplets to twins: a prospective comparison of pregnancy outcome. Hum Reprod 15:1619–1623

    CAS  PubMed  Article  Google Scholar 

  3. Ferraretti AP, Goossens V, de Mouzon J, Bhattacharya S, Castilla JA, Korsak V et al (2012) European IVF-monitoring (EIM); Consortium for European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE. Hum Reprod 27(9):2571–2584

    CAS  PubMed  Article  Google Scholar 

  4. Antsaklis A, Souka AP, Daskalakis G, Papantoniou N, Koutra P, Kavalakis Y, Mesogitis S (2004) Embryo reduction versus expectant management in triplet pregnancies. J Matern Fetal Neonatal Med 16(4):219–222

    CAS  PubMed  Article  Google Scholar 

  5. Hasson J, Shapira A, Many A, Jaffa A, Har-Toov J (2011) Reduction of twin pregnancy to singleton: does it improve pregnancy outcome? J Matern Fetal Neonatal Med 24(11):1362–1366

    PubMed  Article  Google Scholar 

  6. Skrablin S, Kuvacic I, Jukic P, Kalafatic D, Peter B (2002) Hospitalization vs. outpatient care in the management of triplet gestations. Int J Gynaecol Obstet 77(3):223–229

    CAS  PubMed  Article  Google Scholar 

  7. Dodd J, Crowther C (2004) Multifetal pregnancy reduction of triplet and higher-order multiple pregnancies to twins. Fertil Steril 81(5):1420–1422

    PubMed  Article  Google Scholar 

  8. Yaron Y, Bryant-Greenwood PK, Dave N, Moldenhauer JS, Kramer RL, Johnson MP, Evans MI (1999) Multifetal pregnancy reductions of triplets to twins: comparison with nonreduced triplets and twins. Am J Obstet Gynecol 180(5):1268–1271

    CAS  PubMed  Google Scholar 

  9. Ata B, Rasillo LJ, Sukhdeo S, Son WY, Tan SL, Dahan MH (2011) Obstetric outcomes of IVF trichorionic triamniotic triplets which are spontaneously or electively reduced to twins. J Assist Reprod Genet 28(12):1217–1222

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  10. Wimalasundera RC (2010) Selective reduction and termination of multiple pregnancies. Semin Fetal Neonatal Med 15(6):327–335

    CAS  PubMed  Article  Google Scholar 

  11. Lipitz S, Uval J, Achiron R, Schiff E, Lusky A, Reichman B (1996) Outcome of twin pregnancies reduced from triplets compared with nonreduced twin gestations. Obstet Gynecol 87(4):511–514

    CAS  PubMed  Article  Google Scholar 

  12. Kadhel P, Olivennes F, Fernandez H, Vial M, Frydman R (1998) Are there still obstetric and perinatal benefits for selective embryo reduction of triplet pregnancies? Hum Reprod 13(12):3555–3559

    CAS  PubMed  Article  Google Scholar 

  13. Skrablin S, Kuvacic I, Kalafatic D, Peter B, Gveric-Ahmetasevic S, Letica-Protega N, Polak-Babic J (2002) Perinatal care improves the outcome of triplets. Eur J Obstet Gynecol Reprod Biol 104(1):26–31

    PubMed  Article  Google Scholar 

  14. Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH (2006) Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod 21(7):1912–1917

    CAS  PubMed  Article  Google Scholar 

  15. Skiadas CC, Missmer SA, Benson CB, Acker D, Racowsky C (2011) Spontaneous reduction before 12 weeks’ gestation and selective reduction similarly extend time to delivery in in vitro fertilization of trichorionic-triamniotic triplets. Fertil Steril 95(2):596–599

    PubMed  Article  Google Scholar 

  16. Dickey RP, Taylor SN, Lu PY, Sartor BM, Storment JM, Rye PH et al (2002) Spontaneous reduction of multiple pregnancy: incidence and effect on outcome. Am J Obstet Gynecol 186(1):77–83

    PubMed  Google Scholar 

  17. Berkowitz RL, Lynch L, Lapinski R, Bergh P (1993) First-trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases. Am J Obstet Gynecol 169(1):17–21

    CAS  PubMed  Google Scholar 

  18. Hwang JL, Pan HS, Huang LW, Lee CY, Tsai YL (2002) Comparison of the outcomes of primary twin pregnancies and twin pregnancies following fetal reduction. Arch Gynecol Obstet 267(2):60–63

    PubMed  Article  Google Scholar 

  19. American College of Obstetricians and Gynecologists, Committee on Practice Bulletins—Obstetrics (2012) ACOG practice bulletin no. 127: Management of preterm labor. Obstet Gynecol 119(6):1308–1317

    Article  Google Scholar 

  20. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM (2001) The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 20(1):IX–XIV

    CAS  PubMed  Article  Google Scholar 

  21. Kaymak O, Iskender CT, Ustunyurt E, Yildiz Y, Doganay M, Danisman N (2011) Retrospective evaluation of perinatal outcome in women with mild gestational hyperglycemia. J Obstet Gynaecol Res 37(8):986–991

    PubMed  Article  Google Scholar 

  22. Tanaka S, Stock SJ, Yamamoto Y, Kondejewski J, Olson DM (2010) Understanding perinatal mortality. Obstet Gynecol 20(11):317–322

    Google Scholar 

  23. Groutz A, Yovel I, Amit A, Yaron Y, Azem F, Lessing JB (1996) Pregnancy outcome after multifetal pregnancy reduction to twins compared with spontaneously conceived twins. Hum Reprod 11(6):1334–1336

    CAS  PubMed  Article  Google Scholar 

  24. Smith-Levitin M, Kowalik A, Birnholz J, Skupski DW, Hutson JM, Chervenak FA, Rosenwaks Z (1996) Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations. Am J Obstet Gynecol 175(4 Pt 1):878–882

    CAS  PubMed  Google Scholar 

  25. Leondires MP, Ernst SD, Miller BT, Scott RT Jr (2000) Triplets: outcomes of expectant management versus multifetal reduction for 127 pregnancies. Am J Obstet Gynecol 183(2):454–459

    CAS  PubMed  Google Scholar 

  26. Melgar CA, Rosenfeld DL, Rawlinson K, Greenberg M (1991) Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations. Obstet Gynecol 78(5 Pt 1):763–767

    CAS  PubMed  Google Scholar 

  27. Dodd JM, Crowther CA (2003) Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies. Cochrane Database Syst Rev (2):CD003932

Download references

Conflict of interest

None.

Author information

Affiliations

  1. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey

    Emre Okyay

  2. Division of Perinatology, Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Sabahattin Altunyurt

  3. Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Didem Soysal

  4. Division of Perinatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey

    Oktay Kaymak, Sunullah Soysal & Nuri Danisman

  5. Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Bulent Gulekli

Authors
  1. Emre Okyay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabahattin Altunyurt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Didem Soysal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oktay Kaymak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sunullah Soysal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nuri Danisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bulent Gulekli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emre Okyay.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Okyay, E., Altunyurt, S., Soysal, D. et al. A comparative study of obstetric outcomes in electively or spontaneously reduced triplet pregnancies. Arch Gynecol Obstet 290, 177–184 (2014). https://doi.org/10.1007/s00404-014-3175-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-014-3175-y

Keywords

  • Assisted reproduction
  • Multiple pregnancy
  • Fetal reduction
  • Outcomes