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Short-term and long-term outcomes of expectant management compared to embryo reduction to a twin pregnancy in women with triplet pregnancy: a retrospective cohort study
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  • Ji Yeon LeeOrcid,
  • Seung Mi Lee,
  • Mina Jeong,
  • Sohee Oh,
  • Subeen Hong,
  • Jong Kwan Jun
Ji Yeon Lee
Orcid
CHA Bundang Medical Center, CHA University School of Medicine
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Seung Mi Lee
Seoul National University College of Medicine
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Mina Jeong
Seoul National University College of Medicine
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Sohee Oh
Seoul National University Seoul Metropolitan Government Boramae Medical Center
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Subeen Hong
Seoul National University College of Medicine
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Jong Kwan Jun
Seoul National University College of Medicine
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Peer review status:UNDER REVIEW

19 Apr 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
20 Apr 2020Submission Checks Completed
20 Apr 2020Assigned to Editor
21 Apr 2020Reviewer(s) Assigned
26 Apr 2020Review(s) Completed, Editorial Evaluation Pending
11 May 2020Editorial Decision: Revise Major
14 Jun 20201st Revision Received
25 Jun 2020Submission Checks Completed
25 Jun 2020Assigned to Editor
26 Jun 2020Reviewer(s) Assigned

Abstract

Objective: To compare maternal, perinatal and long-term outcome of triplet pregnancies managed expectantly with those reduced to twins Design: A retrospective cohort study Setting: Tertiary medical institutions in South Korea Population: We examined short-term and long-term outcomes in 524 triplet pregnancies with three live fetuses before 14 weeks of gestation that were comprised of expectant management(EM) group (n=213) and embryo reduction(ER) group (n=311) from 2006 to 2017. Methods: The two groups were compared for the following outcomes. Main Outcome Measures: 1) the rates of non-viable pregnancy loss before 23 weeks, 2) the rates of preterm birth before 32 weeks of gestation; 3) the number of survival fetuses; and 4) long term neurodevelopmental outcomes. Results: In the EM group, the risk of preterm delivery (<36, <34, <32, and <28 weeks) was higher compared to the ER group. However, the risk of non-viable pregnancy loss was lower [2(0.9%) vs. 20(6.4%), p=0.008] in EM group, and the rate of cases with at least one alive neonate were higher in EM group than ER group [208(97.7%) vs. 287(92.3), p=0.013]. The survival rate until discharge of neonates were also significantly higher in the EM group than the ER group [607(95.0%) vs. 545(87.6), p=0.001]. The risk of developmental delay or cerebral palsy in survived neonates was not different between the two groups of cases. Conclusions: In triplet pregnancies, EM may improve the chance of fetal survival, without any significant differences in developmental delay and cerebral palsy.