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Expectant management versus multifetal pregnancy reduction in higher order multiple pregnancies containing a monochorionic pair and a review of the literature

Archives of Gynecology and Obstetrics volume 294, pages 1167–1173 (2016)Cite this article

Abstract

Purpose

To compare the perinatal outcome in multifetal pregnancies containing a monochorionic twin pair, managed either expectantly or by fetal reduction (MFPR).

Methods

This was a retrospective analysis of prospectively collected data on 47 triplet and 10 quadruplet pregnancies recruited between 10 and 14 weeks. Main outcome measures were miscarriage <24 weeks, preterm birth, fetal growth restriction, birth weight and survival rates.

Results

For triplets the miscarriage rates <24 weeks were 6.3 % after reduction and 20.0 % for expectant management and MFPR, respectively. While we recorded no case of severe preterm delivery <30 weeks in the reduction group, it was 25 % in those with expectant management. Mean gestational age and birth weight were significantly higher after fetal reduction than for the conservative approach (37.7 ± 1.6 weeks vs. 30.9 ± 3.2 weeks, p < 0.01 and 2676 ± 705 g vs. 1429 ± 542 g, p < 0.01). Expectantly managed triplets were complicated by twin–twin transfusion syndrome in 18.8 % and intrauterine fetal death in 8.3 %. Survival rates were 85.4 % for those managed expectantly and 80.0 % after fetal reduction. Mean gestational age of ongoing quadruplets was 26.9 ± 2.0 weeks vs. 34.5 ± 4.3 weeks for those with reduction of the monochorionic pair (p < 0.05). Survival rates were 100 % in the reduction group and 58.3 % in the expectant management group (p < 0.05). There was an inverse correlation between the final number of fetuses and the birth weight.

Conclusion

Fetal reduction in triplets and quadruplets including a monochorionic pair is associated with decreased early prematurity. While in quadruplets the overall survival is higher after reduction, there was no difference for dichorionic triplets with reduction or conservative management. Complications owing to monochorionicity are frequently observed.

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Affiliations

  1. Department of Obstetrics and Prenatal Medicine, University Medical School Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Judith Sarah Abel, Anne Flöck, Christoph Berg, Ulrich Gembruch & Annegret Geipel

  2. Division of Prenatal Medicine and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, University Medical School Cologne, Cologne, Germany

    Judith Sarah Abel & Christoph Berg

Authors
  1. Judith Sarah Abel
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  2. Anne Flöck
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  3. Christoph Berg
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  4. Ulrich Gembruch
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  5. Annegret Geipel
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Corresponding author

Correspondence to Annegret Geipel.

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Ethical approval

The institutional review boards of the University of Bonn do not require formal approval for retrospective archive studies therefore an ethical approval was not sought.

Conflict of interest

The authors declare no conflict of interest.

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Abel, J.S., Flöck, A., Berg, C. et al. Expectant management versus multifetal pregnancy reduction in higher order multiple pregnancies containing a monochorionic pair and a review of the literature. Arch Gynecol Obstet 294, 1167–1173 (2016). https://doi.org/10.1007/s00404-016-4145-3

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  • DOI: https://doi.org/10.1007/s00404-016-4145-3

Keywords

  • Triplet pregnancy
  • Dichorionic
  • Monochorionic
  • Multifetal pregnancy reduction
  • Embryo reduction
  • Perinatal outcome