Pregnancy outcomes after fetal reduction vs. expectant management of triplet pregnancies: A systematic review and meta-analysis

Abstract

Objective: This study critically appraises the role of embryo reduction (ER) in managing triplet pregnancies, assessing the risks of miscarriage and pre-term delivery to clarify its strengths and weaknesses.

Methodology: PubMed, Embase, and Scopus were searched to identify relevant studies published up until 31 December 2025. Once identified, a random-effects meta-analysis was performed. Pooled effect sizes were reported as odds ratio (OR) or weighted mean difference (WMD) along with 95% confidence intervals.

Results: Twelve studies were included. The findings from the meta-analysis revealed a significant association between expectant management and pre-term delivery (singleton: OR 0.04, 95% CI: 0.02, 0.10; twins: OR 0.25, 95% CI: 0.15, 0.41), and gestational-age (in weeks) (singleton: WMD 5.53, 95% CI: 4.43, 6.64; twins: WMD 2.59, 95% CI: 2.01, 3.18). No significant association was found between ER and risk of miscarriage as well as survival rates until live birth, when compared to expectant management.

Conclusions: ER in triplet pregnancies significantly reduces the risk of pre-term delivery and increases gestational age at birth compared to expectant management. However, ER does not significantly affect the risk of miscarriage or survival rates until live birth.