Fetal reduction strategies in dichorionic triamniotic and monochorionic triamniotic triplets and pregnancy outcome: A cohort study

OBJECTIVE: Dichorionic triamniotic (DCTA) and monochorionic triamniotic (MCTA) triplet pregnancies are associated with significant maternal and fetal risks. Multifetal pregnancy reduction (MPR) or selective reduction (SR) may improve outcomes, but data specific to these complex chorionic configurations are limited. The aim of the present study was to evaluate fetal reduction strategies and pregnancy outcomes in DCTA and MCTA triplets. METHODS: This retrospective cohort study included 19 triplet pregnancies (14 DCTA, 5 MCTA) managed with MPR or SR at a tertiary care center in India between January 2021 and January 2025. Reductions were performed using intracardiac potassium chloride (KCl) or radiofrequency ablation (RFA), based on chorionicity and patient choice. Outcomes assessed included live birth, gestational age at delivery, and procedural complications. RESULTS: Of the 19 pregnancies, 10 were reduced to singletons and nine to twins (5 MCDA, 4 DCDA). The overall live birth rate was 89.47% (17/19), with 80% in singletons and 100% in twins. Preterm delivery occurred in 89.47% of pregnancies, with 15.78% delivering before 28 weeks. Premature rupture of membranes (PPROM) occurred in four cases (21.05%). Among DCTA pregnancies, RFA was associated with a 100% live birth rate and no extreme preterm births. Complications related to monochorionicity were observed in 31.57% of pregnancies before reduction. CONCLUSION: MPR and SR in DCTA and MCTA triplets are feasible and can yield favorable outcomes when tailored to chorionicity and gestational age. These findings add to existing evidence supporting early, tailored fetal reduction in high-order multiple pregnancies.