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Cerebral palsy in triplet pregnancies with and without iatrogenic reduction

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Iatrogenic fetal reduction is undertaken to try and improve the outcome of multiple pregnancies by reducing the rate of severe preterm delivery. In twin pregnancies, however, spontaneous death of one of the fetuses is associated with increased risk of cerebral palsy (CP) in the survivor. The aim of this study was to determine whether iatrogenic fetal reduction might also increase the prevalence of CP. The database of a tertiary fetal medicine unit was interrogated to identify women with trichorionic triplet pregnancies who had either given birth to three live infants or two live infants following selective fetal reduction. A questionnaire was sent to the women’s general practitioners asking them to report whether any of the children had CP. The results of the questionnaire revealed that the CP prevalence (13.8 per 1000) of 72 children from trichorionic triplet pregnancies reduced to twins by selective termination was similar to that of 111 children from trichorionic triplet pregnancies with no loss (18 per 1000), but the pregnancies with selective termination delivered at a later gestation ( P =0.004). Conclusion:a lower cerebral palsy rate might have been expected in the pregnancies with selective termination given that they were delivered at a later gestational age; these data, therefore, emphasise the importance of further investigating the impact of selective reduction on the prevalence of cerebral palsy.

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CP :

cerebral palsy


  1. 1.

    Blickstein I (1999) Cerebral palsy in multifetal pregnancies: facts and hypothesis. In: Chevenak FA, Kurjak A (eds) Fetal medicine – the clinical care of the fetus as a patient. Panthenon Publishing, Lancaster, pp 368–373

  2. 2.

    Evans M, Krivchenia M, Gelber S, Wapner R (2003) Selective reduction. Clin Perinatol 30: 103–111

    PubMed  Google Scholar 

  3. 3.

    Fusi L, McParland P, Fisk N, Nicolini U, Wigglesworth J (1991) Acute twin-twin transfusion: a possible mechanism for brain-damaged survivors after intrauterine death of a monochorionic twin. Obstet Gynecol 78: 517–520

    CAS  PubMed  Google Scholar 

  4. 4.

    Glinianaia SV, Pharoah PO, Wright C, Ranking JM (2002) Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor. Arch Dis Child Fetal Neonatal Ed 86: F9–F15

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Kaufman GE, Malone FD, Harvey-Wilkes KB, Chelmow D, Penzias AS, D’Alton ME (1998) Neonatal morbidity and mortality associated with triplet pregnancy. Obstet Gynecol 91: 342–348

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Kuban KCH, Leviton A (1994) Cerebral palsy. N Engl J Med 330: 188–195

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Maayan-Metzger A, Naor N, Sirota L (2002) Comparative outcome study between triplet and singleton preterm newborns. Acta Paediatr 91: 1208–1211

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Nelson KB, Ellenberg JH (1986) Antecedants of cerebral palsy: multivariate analysis of risk. N Engl J Med 315: 81–86

    CAS  PubMed  Google Scholar 

  9. 9.

    Papageorghiou AT, Liao AW, Skentou C, Sebire NJ, Nicolaides KH (2002) Trichorionic triplet pregnancies at 10–14 weeks: outcome after embryo reduction compared to expectant management. J Matern Fetal Neonatal Med 11: 307–312

    CAS  PubMed  Google Scholar 

  10. 10.

    Petterson B, Nelson NB, Watson L, Stanlay F (1993) Twins, triplets and cerebral palsy in Western Australia in the 1980’s. BMJ 307: 1239–1243

    CAS  PubMed  Google Scholar 

  11. 11.

    Pharoah PO, Cooke T (1996) Cerebral palsy and multiple births. Arch Dis Child Fetal Neonatal Ed 75: F174–F177

    CAS  PubMed  Google Scholar 

  12. 12.

    Pharoah PO, Adi Y (2000) Consequences of in-utero death in a twin pregnancy. Lancet 355: 1597–1602

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Scher AI, Petterson E, Blair E, Ellenberg JH, Grether JK, Haan E, Reddihough DS, Yeargin-Allsopp M, Nelson KB (2002) The risk of mortality or cerebral palsy in twins; a collaborative population-based study. Pediatr Res 52: 671–681

    Article  PubMed  Google Scholar 

  14. 14.

    Wilson-Costello D, Borawski E, Friedman H, Redline R, Fanarott AA, Hack M (1998) Perinatal correlater of cerebral palsy and other neurological impairment among very low birth weight children. Pediatrics 102: 315–322

    CAS  PubMed  Google Scholar 

  15. 15.

    Wimalasundera RC, Trew G, Fish NM (2003) Reducing the incidence of twins and triplets. Best Pract Res Clin Obstet Gynaecol 17: 309–329

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Yokoyama Y, Shimizu T, Hayakawa K (1995) Prevalence of cerebral palsy in twins, triplets and quadruplets. Int J Epidemiol 24: 935–938

    Google Scholar 

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Correspondence to Anne Greenough.

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Dimitriou, G., Pharoah, P.O.D., Nicolaides, K.H. et al. Cerebral palsy in triplet pregnancies with and without iatrogenic reduction. Eur J Pediatr 163, 449–451 (2004).

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  • Cerebral palsy
  • Triplet pregnancy