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Objective: Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies. Methods: This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin‐to‐twin transfusion syndrome (TTTS), twin anemia–polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. Results: Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow‐up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity‐related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks' gestation was 49.2% (61/124). Conclusion: Monochorionicity‐related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article compares the rate of hydrocephalus needing surgical treatment in children with open spina bifida who undergo late open fetal surgery above 26 weeks and those who receive postnatal surgical repair. The study found that late open intrauterine spina bifida repair after 26 weeks is associated with a lower rate of hydrocephalus needing surgical treatment compared to postnatal surgical repair. The fetal surgery group had a lower gestational age at birth, lower frequency of neonatal hydrocephalus, and lower need for ventriculo-peritoneal shunting or neonatal neuroendoscopy for third ventriculostomy. [Extracted from the article]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, discusses the frequency of technical complications during fetal endoscopic tracheal occlusion (FETO) for fetuses with congenital diaphragmatic hernia (CDH). The study was conducted in a single fetal surgery center in Mexico and included 81 CDH fetuses treated with FETO. The researchers found that 14.8% of cases experienced operative technical complications during FETO, including fetoscope dislodgement, fetal presentation changes, catheter rupture, and balloon rupture. The study concludes that while FETO is feasible in all cases, technical complications can be expected in up to 15% of them. [Extracted from the article]

This article, titled "Vascular cannula-assisted tracheal access to simplify fetal endoscopic tracheal occlusion," discusses the use of a plastic vascular cannula to aid in accessing the trachea during fetal endoscopic tracheal occlusion (FETO) in fetuses with congenital diaphragmatic hernia (CDH). The study conducted in a fetal surgery center in Mexico compared cases where FETO was assisted by the vascular introducer to cases without assistance. The results showed that the group assisted by the vascular cannula had shorter intrauterine surgical times and improved access into the fetal trachea. The study concludes that vascular cannula-assisted tracheal access can reduce intrauterine fetoscopic time for tracheal occlusion in CDH fetuses. [Extracted from the article]

This article discusses the impact of fetal laser ablation of the feeding artery in non-hydropic fetuses with large bronchopulmonary sequestration (BPS). The study was conducted in a single fetal surgery center in Mexico from January 2012 to February 2024. The results showed that fetal laser ablation of the feeding artery successfully reduced the size of the lung mass in all cases, and none of the neonates required mechanical ventilation or oxygen support. The authors conclude that this procedure can avoid the need for neonatal sequestrectomy in non-hydropic fetuses with large BPS and mediastinal shift. [Extracted from the article]

This article discusses the perinatal outcomes of the pump twin following early ultrasound-guided intrafetal laser treatment for twin reversed arterial perfusion (TRAP) sequence in monochorionic diamniotic (MCDA) twin pregnancies. The study analyzed 21 cases and found that none of the pump twins presented hydrops at the time of laser treatment, but some had pericardial effusion and tricuspid regurgitation. Fetal demise of the pump twin occurred in 38% of the cases, with most deaths occurring within the first week after treatment. The overall survival rate of the pump twin was 62%. [Extracted from the article]