Pregnancy outcomes of dichorionic triamniotic triplet pregnancies after in vitro fertilization-embryo transfer: multifoetal pregnancy reduction versus expectant management
Abstract Background: Trichorionic triplet pregnancy reduction to twin pregnancy is associated with a lower risk of preterm delivery but not of miscarriage. However, reports on dichorionic triamniotic (DCTA) triplet pregnancy outcomes are few. This study aimed to compare the pregnancy outcomes of reducing DCTA triplets achieved via in vitro fertilization-embryo transfer (IVF-ET) to monochorionic (MC) singleton or monochorionic diamniotic (MCDA) twin pregnancies at 11-13+6 gestational weeks to the pregnancy outcomes of expectant management. Method: Two hundred and ninety-eight patients with DCTA triplets via IVF-ET from January 2012 to December 2016 were retrospectively analysed. All foetuses were alive until 11-13+6 gestational weeks. Eighty-four DCTA triplet pregnancies were reduced to MC singleton pregnancies (group A), 149 were reduced to MCDA pregnancies (group B), and 65 were managed expectantly (group C). Each multifoetal pregnancy reduction (MFPR) was performed at 11-13+6 gestational weeks. Pregnancy outcomes were compared among these 3 groups. Result(s): There were no significant differences in the miscarriage rates (4.8 vs. 2.7 vs. 6.2%, respectively) or live birth rates (90.5 vs. 87.2 vs. 86.2%, respectively) among groups A, B and C (P > 0.05). Group A had significantly lower preterm delivery (11.9 vs. 89.2%; odds ratio (OR) 0.016, 95% confidence interval (CI) 0.006-0.045) and low birth weight rates (LBW; 9.2 vs. 92.9%; OR 0.008, 95% CI 0.003-0.021) than group C (P < 0.001). Group B had significantly lower preterm delivery (51.7 vs. 89.2%; OR 0.129, 95% CI 0.055-0.301) and LBW rates (59.0 vs. 92.9%; OR 0.111, 95% CI 0.057-0.214) than group C (P < 0.001). Group A had significantly lower preterm delivery (11.9 vs. 51.7%; OR 0.126, 95% CI 0.061-0.263; P < 0.001), LBW (9.2 vs. 59.0%; OR 0.071, 95% CI 0.031-0.160; P < 0.001) and perinatal mortality rates (5.0 vs. 13.4%; OR 0.339, 95% CI 0.117-0.978; P = 0.037) than group B. Conclusion: The MFPR of DCTA triplet pregnancies to singleton or MCDA pregnancies was associated with better pregnancy outcomes than DCTA triplets managed expectantly. The perinatal outcomes of DCTA triplets reduced to singleton pregnancies were better than those of DCTA triplets reduced to MCDA pregnancies.