Outcome of dichorionic triamniotic triplet: the experience from an emerging fetal therapy center
Luming Sun1, Gang Zou1, Fenhe Zhou1
1a Department of Prenatal Diagnosis and Fetal Medicine , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China.
Objectives:
To report a cohort of dichorionic triamniotic (DCTA) triplets with access to contemporary fetal interventions.
Design:
Prospective study.
Setting:
A regional referral center for the diagnosis and management of complicated multiple pregnancies.
Population:
All DCTA triplets receiving consultation and prenatal care at our center from 2010 to 2015.
Methods:
The following management alternatives for DCTA were offered: 1) expectant management; 2) reduction of one or two fetus of the monochorionic (MC) component using radiofrequency ablation (RFA) after 16 weeks or potassium chloride (KCL) before 16 weeks, respectively; 3) reduction of the isolated fetus using KCL before 16 weeks.
Main Outcome Measure:
Survival rate of different management alternatives.
Results:
A total of 47 DCTA triplets were included in this study. After consultations on possible prognosis and management options, 19 patients chose expectant management, 14 patients opted RFA to reduce one fetus of the MC component, 14 patients required KCL to reduce the MC component. Fetal demise per pregnancy occurred more frequently in the subgroup managed expectantly (53%) compared to subgroups managed with RFA (7%, p = .02) or KCL (0%, p = .02). Overall survival was significantly lower in DCTA triplets managed expectantly (58%) compared to subgroup managed with RFA (93%, p < .01) or KCL (100%, p = .04).
Conclusion:
Fetal reduction seems to improve perinatal survival in DCTA triplets.
