Perinatal outcomes in multifetal pregnancy following fetal reduction
Neda Razaz1, Tehila Avitan2, Joseph Ting2
1Department of Obstetrics and Gynaecology (Razaz, Pressey, Joseph), University of British Columbia, and BC Women's Hospital and Health Centre, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Razaz), Karolinska University Hospital in Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Avitan), Hadassah Medical Centre, Jerusalem, Israel; Department of Pediatrics (Ting) and School of Population and Public Health (Joseph), University of British Columbia, Vancouver, BC neda.razaz@gmail.com.
Background:
There is currently insufficient evidence regarding the prognosis of multifetal pregnancy following elective fetal reduction to twin or singleton pregnancy. We compared perinatal outcomes in pregnancies with and without fetal reduction.
Methods:
We used data on all stillbirths and live births in British Columbia, Canada, from 2009 to 2013. We compared outcomes of multifetal pregnancies with fetal reduction (to twin or singleton pregnancy) with outcomes of pregnancies without fetal reduction. The primary outcome was a composite of serious neonatal morbidity or perinatal death. Other outcomes studied included preterm birth, low birth weight and small-for-gestational-age live birth.
Results:
The rate of serious neonatal morbidity or perinatal death did not differ significantly between pregnancies reduced to twins and unreduced triplet pregnancies (adjusted rate ratio 0.50, 95% confidence interval [CI] 0.24-1.07) or between pregnancies reduced to singletons and unreduced twin pregnancies (adjusted rate ratio 1.57, 95% CI 0.74-3.33). The rate was significantly lower in the fetal reduction group reduced to twins versus unreduced triplet pregnancies when we restricted the analysis to pregnancies conceived following the use of assisted reproduction technologies (adjusted rate ratio 0.35, 95% CI 0.18-0.67). The rates of preterm birth, very preterm birth, low birth weight and very low birth weight were significantly lower among pregnancies reduced to twins than among unreduced triplet pregnancies. Compared with unreduced twin pregnancies, pregnancies reduced to singletons had lower rates of preterm birth and low birth weight.
Interpretation:
Fetal reduction to twins and singletons was not associated with a decreased risk of serious neonatal morbidity or perinatal death. However, such fetal reduction was associated with substantial improvements in several other perinatal outcomes, such as preterm birth and low birth weight. Clinicians discussing the risks associated with multifetal pregnancy should counsel parents on the potential risks and benefits of fetal reduction.
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