Early fetal reduction to twin versus prophylactic cervical cerclage for triplet pregnancies conceived with assisted reproductive techniques

Objective

To compare the obstetric outcomes of triplet gestations managed by early fetal reduction to twins with those managed by prophylactic cervical cerclage in women conceived with assisted reproductive techniques (ART).

Materials and methods

Retrospective study of the pregnancy and neonatal outcomes of trichorionic triplet gestations achieved by ART and managed either by early transvaginal fetal reduction to twins (n = 53) or by prophylactic placement of cervical cerclage (n = 65).

Results

The pregnancy duration was significantly longer with fetal reduction and the incidences of delivery before 34 and 32 weeks gestational age were significantly lower with fetal reduction. Both miscarriage and live birth rates were comparable in the two groups. The incidences of very low birth weight (VLBW), neonatal respiratory distress syndrome (RDS), admission to neonatal intensive care unit (NICU) and early neonatal death (END) were significantly lower with fetal reduction.

Conclusion

Early transvaginal reduction of triplets to twins leads to improved obstetric outcomes as it decreases prematurity and its related neonatal morbidities and mortality without increase in the miscarriage rate. Early fetal reduction seems to be better than continuation of triplet pregnancies with prophylactic placement of cervical cerclage.