Intrafetal laser ablation for embryo reduction from dichorionic triplets to dichorionic twins
P Chaveeva1,2, G Peeva1, S G Pugliese1
1Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Summary
Selective embryo reduction of dichorionic triplet pregnancies to dichorionic twins using intrafetal laser ablation resulted in lower miscarriage and preterm birth rates. However, approximately half of these procedures led to the birth of a single baby instead of twins.
Area of Science:
- Maternal-Fetal Medicine
- Reproductive Surgery
- Perinatology
Background:
- Dichorionic (DC) triplet pregnancies pose management challenges.
- Selective embryo reduction (ER) is an option to improve pregnancy outcomes.
- Laser ablation is a technique used for ER.
Purpose of the Study:
- To evaluate the outcomes of DC triplet pregnancies reduced to DC twins via intrafetal laser ablation.
- To compare this method with other ER techniques and expectant management.
Main Methods:
- Intrafetal laser embryo reduction (ER) was performed on 61 DC triplet pregnancies.
- The procedure aimed to reduce triplets to dichorionic twins.
- Pregnancy outcomes were monitored post-procedure.
Main Results:
- Laser ablation was successful in all cases.
- The monochorionic cotwin survived in 54.1% of cases; the other 45.9% did not.
- The overall miscarriage rate was 3.3%, and preterm birth before 33 weeks was 6.8%.
Conclusions:
- Intrafetal laser ablation for ER in DC triplets to DC twins is associated with reduced miscarriage and early preterm birth rates.
- This method appears superior to expectant management or potassium chloride injection for ER.
- A significant proportion of these pregnancies result in a single live birth rather than twins.
