Cerebral palsy in triplet pregnancies with and without iatrogenic reduction

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).

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.