Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre...

Area of Science:

• Maternal-Fetal Medicine
• Reproductive Medicine
• Neonatal Outcomes

Background:

• Multifetal pregnancy reduction (MFPR) is known to reduce risks in trichorionic triplets.
• Dichorionic triamniotic (DCTA) pregnancies may also benefit from MFPR, but various reduction methods exist.
• The influence of different MFPR methods on outcomes in DCTA pregnancies is not well-established.

Purpose of the Study:

• To investigate if the method of MFPR influences the benefits observed in DCTA triplet pregnancies.
• To compare neonatal survival and other outcomes based on MFPR technique in DCTA pregnancies.

Main Methods:

• Retrospective cohort study of DCTA pregnancies (2010-2019) at a UK tertiary referral center.
• Cohorts were defined by MFPR decision and method (radiofrequency ablation, intrafetal laser, KCl injection, or expectant management).
• Primary outcome: offspring survival until neonatal discharge. Secondary outcomes: miscarriage, preterm birth, SGA, and maternal morbidity. Cox regression and univariate analysis were used.

Main Results:

• 83 DCTA pregnancies were analyzed. Radiofrequency ablation (RFA) resulted in the highest neonatal survival to discharge (89%).
• Expectant management was associated with increased rates of delivery before 32 weeks, low birth weight, and small for gestational age neonates compared to reduction groups.
• No significant difference in miscarriage rates was observed between the groups.

Conclusions:

• MFPR using radiofrequency ablation (RFA) is beneficial for improving neonatal survival until discharge in DCTA triplet pregnancies.
• RFA is an established and widely available procedure that promotes better neonatal outcomes in this high-risk pregnancy group.