Risk of premature delivery and fetal loss in trichorionic triplet pregnancies: multicenter study on fetal reduction versus expectant management

Objective: to assess the impact of embryo-reduction (ER) in reducing the risk of miscarriage and premature birth in trichorionic triplet pregnancies. Short term outcome, incidence of cerebral palsy and periventricular leukomalacia were evaluated for each neonate of both groupes. Materials and methods: pregnancies enrolled for this study were recruited in the Unit of Prenatal Diagnosis of Piero Palagi Hospital, USL Centro Toscana, Florence and Unit of Fetal Medicine of Careggi Hospital, University of Florence. This was a multicentric retrospective study on trichorionic triamniotic triplet pregnancies with three live fetuses at 10–13 +6 weeks of gestation managed expectantly or by ER. The two groups were compared for the rates of miscarriage, defined as pregnancy loss before 24 weeks, early preterm birth before 32 weeks, birth weight and early neonatal outcome. Short term outcome, incidence of cerebral palsy and periventricular leukomalacia were evaluated for each neonate of both groupes. Results: 86 trichorionic triamniotic pregnancies met our inclusion criteria. 60 (69,8 %) opted for expectant management (group 1); 26 (30,2%) had ER in the first trimester (10–13 +6 weeks) (group 2). The percentage of miscarriage were not significantly different between the two groups (p=0,688), otherwise the percentage of early preterm delivery before 32 weeks was higher in those managed expectantly (20/60, 33.3%) group 1, 1/26 (3,8%) group 2 (p <0.006). The incidence of cerebral palsy and periventricular leukomalacia were not significantly different between the two groups. Discussion: results of our study are consistent with international literature confirming that ER is associated with an increased gestational age at birth and mean birth weight, without any difference in terms of early neonatal outcome; however the ER procedure does not seem to increase the rate of miscarriage. Our data are not sufficient to recommend a policy of pregnancy reduction to women with trichorionic triplet pregnancies.