Comparison of maternal and perinatal outcomes of multifetal pregnancy reduction versus conservative management in triplet pregnancies

The increased use of assisted reproductive technologies (ART) has led to an increase in the frequency of multiple pregnancies. Multiple pregnancies are associated with higher maternal and fetal morbidity compared to singleton pregnancies. Multifetal pregnancy reduction (MFPR) can be performed to reduce these risks. This study aimed to compare the maternal and perinatal outcomes of triplet pregnancies undergoing MFPR with those followed without intervention. This retrospective cohort study was conducted in a tertiary obstetrics and gynecology clinic over 10 years (January 2014-January 2024). All triplet pregnancies received counseling regarding MFPR. Pregnancies reduced from triplets to twins constituted the MFPR group, while those followed without intervention constituted the conservative management group. Demographic data, obstetric history, and pregnancy outcomes were compared using appropriate statistical tests. A total of 187 triplet pregnancies (MFPR, n = 47; conservative management, n = 140) were examined. No significant differences were found between the groups in terms of maternal age, parity, history of miscarriage or preterm birth (P > .05). The gestational age at delivery was higher in the MFPR (35.2 vs 32.2 wk, P = .003). In triplet pregnancies, conservative treatment was an independent risk factor for delivery at <34 weeks (OR 2.4), cesarean delivery (OR 3.4), and need for NICU (OR 10.6) (all P < .05). Neonatal mortality was 5% in the conservative management and not in the MFPR. The MFPR procedure of triplets can significantly prolong gestational age, reduce the need for NICU, and improve perinatal prognosis. Because it provides these benefits without increasing maternal complications, MFPR should be offered as an option to patients and their families in the first trimester.