Clinical Analysis Of Pregnancy Outcomes And Fetal Loss Between Fetal Reduction Of Triplets To Twins And Singletons

ObjectiveTo investigate and evaluate the pregnancy outcomes and the risk of fetal loss、maternal gestational diabetes mellitus (GDM)、hypertensive disorders of pregnancy between fetal reduction of triplets to twins and singletons.MethodsWe analyzed 282 cases of triplets (including 11 cases conceived naturally and the remaining by assisted reproductive technologies (ART)) opted to multi-fetal pregnancy reduction (MFPR) who cared for at our obstetric department in Shandong Provincial Hospital affiliated to Shandong University from Sep,2001 to Mar,2014. According to the final number of fetus after MFPR,231 cases opted to reduce to twins (twins group) while 51 pregnancies opted to singletons (singletons group). The former was owing to fetal abnormalities under ultrasound or patients’ aspiration; the later included dichorionic triamniotic (DCTA) triplets or patients’ aspiration. On the mode of conception of all 282cases, ovulation induction was 37.2% (105/282), in vitro fertilization and embryo transfer(IVF-ET) 58.9%(166/282), spontaneous conception 3.9% (11/282). Median gestational age at procedure was (14.9±2.6) weeks,ranging from 11.6 weeks to 22.5 weeks. The women average age was 29.73±4.23) years. Potassium chloride was injected to targeted fetal heart until cardiac standstill was obtained..We analyzed the pregnancy outcomes、gestational age at delivery、birth weight of newborns、maternal gestational diabetes mellitus (GDM)、hypertensive disorders of pregnancy and so on between two groups. Take-home at least one baby is defined as successful pregnancy. Diagnostic criteria for maternal gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy were refered to the standards issued by the ministry of health in China in 2011 and 2012, respectively.Results1. The overall rate of successful pregnancy outcome was 91.5% (258/282). Twins group was a total of 413 neonates, including 4 cases neonatal mortality and 409 live births, so the successful rate was 90.5%(209/231); Singletons group was a total of 49 neonates, including 2 cases fetal loss, thus the successful rate was 96.1%(49/51). The rate of successful pregnancy was not different between two groups (P>0.05)2. The mean gestational age at operation above were (14.2±2.0) w and (16.5±3.5)w, respectively. We divided into three periods 11—13+6 w、14+—16+6 w、 ≥17 w.The twins group were 129 cases(55.8%,129/231)、50cases(21.6%,50/231)、 52cases (22.5%,52/231) separately whereas the singletons group were 27cases (52.9%,27/51)、16cases (31.4%,16/51).8cases (15.7%,8/51).There was no difference above at the aspects of the number of women at three periods (P>0.05)3. The rate of fetal loss in the triplets to twins were 7.0%(9/129)、12.0%(6/50)、 9.6%(5/52) at three different periods separately while the singletons group were 3.7% (1/27)、0 (0/16)、1/8 separately. There was no significant difference above (P >0.05).4. The mean birth weight was different between groups as lower compared with singletons group (2 555±447g vs 3 084±550g, respectively, P<0.05).The rate of low birth weight infants (<2 499 g)between twins and singletons group were 45.5% (188/413)and 8.2% (4/49), respectively(P<0.05).The rate of very low birth weight infants (<1499 g) was 3.9%(16/413) in the twins group compared with 0 (0/49) in the singletons group (P>0.05)5. The rate of gestational age at delivery was different between groups as deliveries occurred earlier in twins compared with singletons group ((36.2±2.4) weeks vs (38.3 ±2.2) weeks,respectively, P<0.05).At the aspects of rate of labor,there were both significant difference between two groups at the below periods of 34—36+6w and ≥37w (P<0.05).The rate of full-term deliveries in the twins was 47.6%(110/231) compared with 88.2%(45/51) in the reduction to singletons (P <0.05). The fetal loss rate before 28 weeks did not differ between fetal reduction of triplets to twins and singletons (8.7%(20/231) vs 3.9%(2/51), P>0.05).6. The overall incidence of maternal gestational diabetes mellitus (GDM) and hypertensive respectively. The maternal hypertensive disorders of pregnancy morbidity was not different between twin group as higher compared with singletons group (10.4%(24/231) vs2.0%(1/51), P>0.05). The risk of maternal GDM did not differ between fetal reduction of triplets to twins and singletons 4.8% (11/231) vs 3.9%(2/51), P>0.05). Cesarean delivery was higher in twin group(90.0%(208/231) than in singletons 58.8%(30/51) (P<0.05).ConclusionsReduction to one rather than two fetuses led to significantly better outcomes at the aspects of gestational age at delivery and neonatal birth weight, without significant differences in fetal loss rate. So, for triplets we can advise patients to reduce to singletons in order to improve the pregnancy outcome.