Universität zu Köln

Abel, Judith Sarah, Floeck, Anne, Berg, Christoph, Gembruch, Ulrich ORCID: 0000-0001-8284-4669 and Geipel, Annegret (2016). Expectant management versus multifetal pregnancy reduction in higher order multiple pregnancies containing a monochorionic pair and a review of the literature. Arch. Gynecol. Obstet., 294 (6). S. 1167 - 1174. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1432-0711

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Abstract

To compare the perinatal outcome in multifetal pregnancies containing a monochorionic twin pair, managed either expectantly or by fetal reduction (MFPR). This was a retrospective analysis of prospectively collected data on 47 triplet and 10 quadruplet pregnancies recruited between 10 and 14 weeks. Main outcome measures were miscarriage < 24 weeks, preterm birth, fetal growth restriction, birth weight and survival rates. For triplets the miscarriage rates < 24 weeks were 6.3 % after reduction and 20.0 % for expectant management and MFPR, respectively. While we recorded no case of severe preterm delivery < 30 weeks in the reduction group, it was 25 % in those with expectant management. Mean gestational age and birth weight were significantly higher after fetal reduction than for the conservative approach (37.7 +/- 1.6 weeks vs. 30.9 +/- 3.2 weeks, p < 0.01 and 2676 +/- 705 g vs. 1429 +/- 542 g, p < 0.01). Expectantly managed triplets were complicated by twin-twin transfusion syndrome in 18.8 % and intrauterine fetal death in 8.3 %. Survival rates were 85.4 % for those managed expectantly and 80.0 % after fetal reduction. Mean gestational age of ongoing quadruplets was 26.9 +/- 2.0 weeks vs. 34.5 +/- 4.3 weeks for those with reduction of the monochorionic pair (p < 0.05). Survival rates were 100 % in the reduction group and 58.3 % in the expectant management group (p < 0.05). There was an inverse correlation between the final number of fetuses and the birth weight. Fetal reduction in triplets and quadruplets including a monochorionic pair is associated with decreased early prematurity. While in quadruplets the overall survival is higher after reduction, there was no difference for dichorionic triplets with reduction or conservative management. Complications owing to monochorionicity are frequently observed.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Abel, Judith Sarah UNSPECIFIED UNSPECIFIED UNSPECIFIED Floeck, Anne UNSPECIFIED UNSPECIFIED UNSPECIFIED Berg, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Gembruch, Ulrich UNSPECIFIED orcid.org/0000-0001-8284-4669 UNSPECIFIED Geipel, Annegret UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-257225
DOI:	10.1007/s00404-016-4145-3
Journal or Publication Title:	Arch. Gynecol. Obstet.
Volume:	294
Number:	6
Page Range:	S. 1167 - 1174
Date:	2016
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1432-0711
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DICHORIONIC TRIPLET PREGNANCIES; EMBRYO REDUCTION; OUTCOMES; MISCARRIAGE; BIRTHS Multiple languages Obstetrics & Gynecology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/25722