Triplets: Outcomes of expectant management versus multifetal reduction for 127 pregnancies

Objective: Our purpose was to compare outcomes of women with triplet gestations conceived via assisted reproductive technology who chose expectant management or multifetal pregnancy reduction. Study Design: We performed a retrospective review of all women who initiated assisted reproductive technology cycles from August 1995 through July 1997 with ultrasonographic documentation of triplets exhibiting fetal heart tones at 9 weeks of gestation (N = 127). Patients were then uniformly referred to a maternal-fetal medicine specialist and to 3 centers offering multifetal pregnancy reduction. Results: Thirty-six percent of patients (46/127) chose multifetal pregnancy reduction with 95% undergoing reduction to twins. In the expectant management group, 13.6% of pregnancies were reduced spontaneously after 9 weeks of gestation. The “take home” infant per delivery rates for the multifetal pregnancy reduction and expectant management groups were 87% and 90.1%, respectively (P = .66). The mean gestational ages at delivery (±SE) for the multifetal pregnancy reduction and expectant management groups were 33.25 ± 1.03 weeks and 32.04 ± 0.58 weeks (P = .23), and the mean birth weights of infants delivered at >24 weeks of gestation were 2226 ± 79 and 1796 ± 44, respectively (P< .0001). There were no significant differences in perinatal mortality, gestational age at delivery, or “take home” infant per delivery rates between these groups. Conclusions: These data suggest that multifetal pregnancy reduction does not have a significant impact on the probability of live birth or on gestational age at delivery for women with triplets conceived with assisted reproductive technology. (Am J Obstet Gynecol 2000;183:454-9.)