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Monochorionic high-order multiple pregnancies and multifetal pregnancy reduction.
Luc De Catte1, Michel Camus, Walter Foulon
1Division of Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Academisch Ziekenhuis VUB, Vrije Universiteit Brussel, Belgium. luc.decatte@az.vub.ac.be
Obstetrics and Gynecology
|September 11, 2002
Summary
Monochorionic twins and triplets are common in high-order pregnancies conceived naturally. Fetal reduction of monochorionic twins improves pregnancy outcomes, while reduction in monochorionic triplets can mitigate complications.
Area of Science:
- Maternal-Fetal Medicine
- Reproductive Medicine
- Genetics
Background:
- High-order multiple pregnancies present unique obstetric challenges.
- Monochorionic (MC) gestations, where twins share a placenta, are associated with increased risks.
- Fetal reduction is a procedure to manage high-order multiples and improve outcomes.
Purpose of the Study:
- To determine the frequency of monochorionic (MC) components in high-order multiple pregnancies referred for fetal reduction.
- To evaluate the obstetric outcomes following fetal reduction in these pregnancies.
Main Methods:
- Retrospective review of 239 high-order multiple pregnancies (> or =3) over 10 years.
- Identification of pregnancies with monochorionic twin or triplet components.
- Analysis of pregnancy outcomes after fetal reduction procedures.
Main Results:
- 12.1% of high-order pregnancies had an MC component, with MC triplets in 8 cases.
- MC pregnancies were more frequent in naturally conceived cases (P=.001).
- Reduction of MC twins to singletons resulted in a mean gestational age of 39.2 weeks; reduction to twins had a mean of 34.3 weeks, with a 4.8% loss rate.
Conclusions:
- Monochorionic twins/triplets are common in naturally conceived high-order multiples.
- Fetal reduction of MC twin pairs significantly improves pregnancy outcomes.
- Monochorionic triplet pregnancies have high complication rates but may benefit from cord coagulation reduction.