Acta obstetricia et gynecologica Scandinavica · 2026
Perinatal outcomes of expectant management versus fetal reduction in triplet pregnancies: A single-center retrospective cohort study in Korea.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Lee Yoo Jin, Chung Jin Hoon, Jeong Jae Yi, Koh Jihye, Lee Mi-Young, Won Hye-Sung
Аннотация
INTRODUCTION: We aimed to evaluate perinatal outcomes in triplet pregnancies and compare outcomes between pregnancies managed expectantly and those undergoing fetal reduction.
MATERIAL AND METHODS: This retrospective study included triplet pregnancies confirmed by ultrasound at Asan Medical Center between January 2020 and May 2025. Pregnancies were classified into an expectant management group or a fetal reduction group (reduction to twins or a singleton). Maternal characteristics, obstetric complications, and perinatal outcomes were compared. Within the fetal reduction group, outcomes were further analyzed by indication-multifetal pregnancy reduction versus selective fetal termination-and method-intracardiac injection versus radiofrequency ablation.
RESULTS: A total of 208 triplet pregnancies were included; 133 (63.9%) were managed expectantly, and 75 (36.1%) underwent fetal reduction. In the expectant management group, the mean gestational age at delivery was 33.2 weeks, with preterm birth before 32 weeks in 21.6%, and neonatal intensive care unit (NICU) admission in 76.7%. Fetal loss of at least one fetus before 24 weeks occurred in 7.8%, and the incidence of nonviable pregnancy loss was 2.3%. Compared with expectant management, the fetal reduction group demonstrated more favorable perinatal outcomes, including higher Apgar scores and lower rates of oxygen therapy (18.4% vs. 50.2%, p < 0.0001) and NICU admission (34.6% vs. 76.7%, p < 0.0001). No nonviable pregnancy loss or stillbirth occurred after reduction, whereas both were observed in the expectant group. Survival rates were similarly high in both groups (100% vs. 98.4%). Within the reduction group, outcomes did not differ significantly by indication or procedure type.
CONCLUSIONS: Triplet pregnancies carry significant maternal and neonatal risks. Fetal reduction appears safe and may improve perinatal outcomes by extending gestation. These findings individualized prenatal counseling and management strategies for triplet pregnancies.
MATERIAL AND METHODS: This retrospective study included triplet pregnancies confirmed by ultrasound at Asan Medical Center between January 2020 and May 2025. Pregnancies were classified into an expectant management group or a fetal reduction group (reduction to twins or a singleton). Maternal characteristics, obstetric complications, and perinatal outcomes were compared. Within the fetal reduction group, outcomes were further analyzed by indication-multifetal pregnancy reduction versus selective fetal termination-and method-intracardiac injection versus radiofrequency ablation.
RESULTS: A total of 208 triplet pregnancies were included; 133 (63.9%) were managed expectantly, and 75 (36.1%) underwent fetal reduction. In the expectant management group, the mean gestational age at delivery was 33.2 weeks, with preterm birth before 32 weeks in 21.6%, and neonatal intensive care unit (NICU) admission in 76.7%. Fetal loss of at least one fetus before 24 weeks occurred in 7.8%, and the incidence of nonviable pregnancy loss was 2.3%. Compared with expectant management, the fetal reduction group demonstrated more favorable perinatal outcomes, including higher Apgar scores and lower rates of oxygen therapy (18.4% vs. 50.2%, p < 0.0001) and NICU admission (34.6% vs. 76.7%, p < 0.0001). No nonviable pregnancy loss or stillbirth occurred after reduction, whereas both were observed in the expectant group. Survival rates were similarly high in both groups (100% vs. 98.4%). Within the reduction group, outcomes did not differ significantly by indication or procedure type.
CONCLUSIONS: Triplet pregnancies carry significant maternal and neonatal risks. Fetal reduction appears safe and may improve perinatal outcomes by extending gestation. These findings individualized prenatal counseling and management strategies for triplet pregnancies.