{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T22:37:05Z","timestamp":1782340625340,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,4,8]],"date-time":"2015-04-08T00:00:00Z","timestamp":1428451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In trichorionic pregnancies, fetal reduction from three to two lowers the risk of severe preterm delivery, but provides no advantage in survival. Similar data for dichorionic triamniotic (<jats:styled-content style=\"fixed-case\">DCTA<\/jats:styled-content>) triplets is not readily available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To document the natural history of <jats:styled-content style=\"fixed-case\">DCTA<\/jats:styled-content> triplets and the effect of reduction on the risk of miscarriage and severe preterm delivery, compared with expectant management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>Systematic search on <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> EMBASE<\/jats:styled-content>, and the Cochrane Library.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">DCTA<\/jats:styled-content> triplets with three live fetuses at 8\u201314\u00a0weeks of gestation, outcome data with expectant management and\/or reduction, miscarriage before 24\u00a0weeks of gestation and\/or severe preterm delivery before 32\u201333\u00a0weeks of gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>Five studies were included. Data from these were combined with data from three centres.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>There were 331 <jats:styled-content style=\"fixed-case\">DCTA<\/jats:styled-content> triplets. The miscarriage rate was 8.9% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 5.8\u201313.3%) and the severe preterm delivery rate was 33.3% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 27.5\u201339.7%), with expectant management. The miscarriage rate was 14.5% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 7.6\u201326.2%) with a reduction of the monochorionic pair, 8.8% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 3.0\u201323.0%) with a reduction of one fetus of the monochorionic pair, and 23.5% (9.6\u201347.3%) with a reduction of the fetus with a separate placenta. Severe preterm delivery rates were 5.5% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.9\u201314\u20109%), 11.8% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 4.7\u201326.6%), and 17.6% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 6.2\u201341.0%), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In <jats:styled-content style=\"fixed-case\">DCTA<\/jats:styled-content> triplets, expectant management is a reasonable choice when the top priority is a liveborn infant. Where the priority is to minimise severe preterm delivery, the most advisable option is fetal reduction. Further studies are needed to clarify which particular technique is advisable to optimise the outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13348","type":"journal-article","created":{"date-parts":[[2015,4,8]],"date-time":"2015-04-08T05:49:30Z","timestamp":1428472170000},"page":"1053-1060","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. 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