Background: Triplet pregnancies are associated with significant perinatal and neonatal morbidity and mortality, often necessitating selective fetal reduction (SFR) to improve outcomes. This study compares perinatal and neonatal outcomes between complicated monochorionic triamniotic (MC-TA) and dichorionic triamniotic (DC-TA) triplet pregnancies undergoing SFR using radiofrequency ablation (RFA).

Materials and Methods: This retrospective cohort study, conducted at Yas Hospital, Tehran, Iran, from March 2017 to March 2024, included all complicated MC-TA and DC-TA triplet pregnancies undergoing RFA between 16 and 26 weeks’ gestation. Outcomes included live birth rate, miscarriage rate, gestational age at delivery, and neonatal metrics (birth weight, Apgar scores, neonatal intensive care unit [NICU) admission). Data were analyzed using SPSS version 24.0, with statistical significance set at p < 0.05.



Results: Of 32 triplet pregnancies (20 DC-TA, 12 MC-TA), the mean gestational age at RFA was significantly lower in MC-TA (19.58 ± 1.8 weeks) than DC-TA (22.3 ± 2.1 weeks; p = 0.005). Twin-to-twin transfusion syndrome (TTTS) was the primary indication for MC-TA (50%), while selective fetal growth restriction (FGR) predominated in DC-TA (45%). The overall pregnancy survival rate was 78.1%, with live birth rates of 70% (MC-TA) and 74.3% (DC-TA; p = 0.72). Miscarriage rates were 25% (MC-TA) and 20% (DC-TA; p = 0.68). Mean gestational age at delivery (MC-TA: 35.1 ± 2.3 weeks; DC-TA: 34.4 ± 3.0 weeks; p = 0.51) and neonatal outcomes (birth weight, Apgar scores, NICU admission) were comparable.



Conclusion: RFA is an effective intervention for SFR in complicated triplet pregnancies, yielding a 78.1% pregnancy survival rate with no significant differences in perinatal or neonatal outcomes between MC-TA and DC-TA groups. RFA is recommended as a safe, minimally invasive option, with post-procedure ultrasound monitoring advised to mitigate complications.