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Effects of selective reduction in triplet gestation: a comparative study of 80 cases managed with or without this
P Boulot1, B Hedon, G Pelliccia
1Centres Hospitaliers et Universitaires de l'Université de Montpellier-Nîmes, France.
Objective:
To evaluate the effect of selective termination in triplet pregnancies.
Design:
Comparative, prospective, nonrandomized study.
Setting:
All 80 pregnancies were managed in a single tertiary center by the same obstetrical team.
Patients:
Eighty women with triplet pregnancies were divided into two groups: group I consisted of 48 women who wished to continue their pregnancies without reduction; in group II were 32 women who choose reduction generally to obtain twins.
Interventions:
Selective terminations were performed after an average term of 9.6 weeks of gestation by transcervical or transabdominal approaches.
Main Outcome Measurements:
The rate of miscarriage and prematurity, fetal growth, perinatal morbidity and mortality, and maternal complications in the two groups.
Results:
Prematurity was lower in reduced pregnancies (95.5% in triplets versus 53.5%), especially between 24 to 32 weeks' gestation where prematurity was reduced by half. Birth weight was > 450 g higher in the reduced group. The perinatal mortality rate was lower for reduced pregnancies, but this difference was not statistically significant. Five life-threatening maternal complications occurred in triplets, with none in the reduced group.
Conclusions:
Selective terminations are effective in decreasing the rate of prematurity, improving fetal growth, and avoiding maternal complications. The procedure thus could be used in triplet gestations. The ultimate decision should be taken by the couple who must be well informed of the risks of the procedure before deciding.