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PubMed1993

A report of 131 cases of multifetal pregnancy reduction.

OBJECTIVE: To evaluate multifetal pregnancy reduction as a treatment for patients seeking to reduce the risks of multiple gestation. METHODS: One hundred thirty-one women had transabdominal multifetal pregnancy reduction performed by a single practitioner; 103 have delivered. RESULTS: Multifetal pregnancy reduction was associated with a 7% pregnancy loss rate and no losses within the first 4 weeks after the procedure. The mean gestational age at delivery overall was 35.5 weeks. The mean gestational age at delivery for singletons was 37.5 weeks, for twins 35.5 weeks, and for triplets 35 weeks. The incidence of maternal and fetal complications was no more than that previously reported for nonreduced multiple gestations. CONCLUSIONS: Multifetal pregnancy reduction is a safe option for patients who desire to reduce the risks of multiple gestation. The ultimate successful outcome of reduced pregnancies may be enhanced by extensive experience with the procedure.

Abortion, Induced↗
PubMed2001

Cervical length after multifetal pregnancy reduction in remaining twin gestations.

OBJECTIVE: Multifetal pregnancy reduction is associated with an increased risk of prematurity. Because cervical length correlates with preterm delivery risk, we sought to determine whether multifetal pregnancy reduction twin gestations are associated with shorter cervical lengths compared with non-multifetal pregnancy reduction twins. STUDY DESIGN: We compared an historic cohort of patients who underwent multifetal pregnancy reduction to twins (n = 35) to a control group of twin gestations without multifetal pregnancy reduction (n = 83) from July 1996 to January 2000. Both groups of patients were treated with identical protocols. Cervical lengths across gestation and pregnancy outcomes were compared. RESULTS: Study and control groups did not differ significantly in mean maternal age (37.8 +/- 4.9 years vs 35.5 +/- 6.2 years; P =.06), median parity (0 [range, 0-1] vs 0 [range, 0-2]; P =.56), or mean gestational age at delivery (36.2 +/- 2.6 weeks vs 35.8 +/- 3.8 weeks; P =.50). The proportion delivering before 35 weeks of gestation was not significantly different (14.3% vs 30.1%; P =.10) nor was delivery before 32 weeks of gestation (8.6% vs 8.4%; P =.98). Cervical length did not differ significantly between the 2 groups. At 14 to 19 weeks the median was 3.9 cm (range, 2.4-6.0 cm) in the multifetal pregnancy reduction group versus 3.7 cm (range, 3.1-4.7 cm) in the control subjects (P =.15); at 20 to 25 weeks, the medians were 3.2 cm (range, 2.2-5.4 cm) and 3.7 cm (range, 1.5-5.7 cm), respectively (P =.43); and at 26 to 31 weeks the medians were 3.5 cm (range, 1.2-5.9 cm) versus 3.8 cm (range, 1.2-5.3 cm), respectively (P =.56). CONCLUSION: Cervical length across gestation in twin pregnancies is not affected by multifetal pregnancy reduction, despite the likely inflammatory response expected to accompany this procedure.

Cervix Uteri↗
PubMed1995

Multifetal pregnancy reduction and selective termination.

Multifetal pregnancy reduction has had a major impact upon perinatal morbidity and mortality following iatrogenic multiple pregnancies. There are still residual risks, however, that are higher for higher order multiples than for pregnancies that started out at lower numbers. There are many, but not complete, parallels between reductions for number per se, and selective termination because of diagnosed abnormalities.

Female↗
PubMed2005

Cervical length, multifetal pregnancy reduction, and prediction of preterm birth.

PURPOSE: To evaluate the application of transvaginal sonography assessment of cervical length before fetal reduction for predicting spontaneous preterm birth in triplet gestations reduced to twins. METHODS: This retrospective study was conducted at the ultrasound unit of a university-affiliated municipal hospital. The study cohort consisted of 25 women with triplet gestations following ovulation induction or assisted-reproduction techniques who underwent fetal reduction to twins. Cervical length was assessed via transvaginal sonography before fetal reduction, and data on pregnancy outcome were retrieved from maternal records and/or maternal interviews. RESULTS: Cervical length (mean +/- SD) at reduction was 4.0 +/- 0.85 (range: 1.2-5.5). Five women were excluded from statistical evaluation because pregnancy complications precluded spontaneous delivery. Two of 3 (67%) women with a cervical length of <3.5 cm delivered prior to 33 weeks' gestation compared with 1/17 (6%) women with a cervical length > or = 3.5 cm. This difference was statistically significant (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of cervical lengths <3.5 cm to predict delivery prior to 33 gestational weeks was 67%, 94%, 67%, and 94%, respectively. CONCLUSIONS: Measurement of cervical length in triplet pregnancies before fetal reduction provides useful predictive information on the risk for preterm delivery.

Adult↗
PubMed1995

Genetic amniocentesis following multifetal pregnancy reduction to twins: assessing the risk.

Fifty-three patients who elected to reduce their pregnancies to a twin gestation in our centre are known to have subsequently undergone genetic amniocentesis. Five of these patients lost entire pregnancy following the genetic amniocentesis procedure. This is equivalent to a 9.4 per cent pregnancy loss rate for reduced twin gestations in comparison with an expected loss rate of 2 per cent for non-reduced twin gestations.

Abortion, Spontaneous↗
PubMed1998

Multifetal pregnancy reduction of both fetuses of a monochorionic pair by intrathoracic potassium chloride injection of one fetus.

The purpose of this study was to determine if a monochorionic pair of fetuses in a higher-order multiple gestation can be reduced by injecting only one fetus with potassium chloride. Three quadruplet and two quintuplet gestations, each with a monochorionic pair of fetuses, were referred for pregnancy reduction. In each case, reduction was performed by injecting one of the monochorionic pair with potassium chloride. Patients returned for a follow-up sonogram within 1 week of the procedure. The reductions were performed at an average 12.1 weeks' gestation, with a range of 10.7 to 14.0 weeks. Follow-up scans 4 to 7 days after the procedure showed that both monochorionic fetuses were dead and all other fetuses were alive. One quintuplet pregnancy underwent a second reduction procedure to twins. One quintuplet and two quadruplet pregnancies that were reduced to twins resulted in the birth of live twins between 30.8 weeks and 36.8 weeks' gestations. The third quadruplet pregnancy reduced to twins is still ongoing; the mother is pregnant with twins at 20 weeks' gestation. The quintuplet pregnancy reduced to triplets resulted in delivery of live triplets at 24.1 weeks' gestation, but two of the neonates died in the first few days of life. Reduction of both fetuses of a monochorionic pair in a higher-order multiple gestation can be accomplished by intrathoracic injection of potassium chloride into only one of the pair.

Female↗
PubMed1996

Ethical issues surrounding multifetal pregnancy reduction and selective termination.

MFPR and selective terminations satisfy the criteria of enabling pregnancies to continue with the least harm and most benefits to all involved. The surviving infants can be saved from certain death (abortion) or higher risks of severe harm and death and of an extended stay in neonatal intensive care (premature delivery). In the hands of trained operators, MFPR and selective termination is, in our opinion, the best means to protect the mother's health and well-being, given it is available and approved by the parents. MFPR and selective termination avoid the trauma of abortion of a wanted pregnancy, enable the parents to achieve the goal of having their own child, and avoid the dangers of delivery of multiple premature infants. There is no doubt that any procedure that involves the death of a fetus will be hotly argued despite the potential for greater good. We acknowledge that it will be impossible to convince those who cannot morally accept the taking of any life regardless of the circumstances. We hope, however, that we have shown there is a place for MFPR and selective termination in a very limited number of circumstances and the ethical probity of MFPR and selective termination as an option in such cases.

Congenital Abnormalities↗
PubMed1995

The psychological effects of multifetal pregnancy reduction.

OBJECTIVE: To study the psychological effects of multifetal pregnancy reduction. DESIGN AND SETTING: Hour-long semistructured telephone interviews with both multifetal pregnancy reduction patients and control subjects. PATIENTS: Forty-two multifetal pregnancy reduction patients were contacted within 1 year of undergoing the procedure. Forty-four control subjects had become pregnant after infertility evaluation or treatment but conceived only a single fetus or twins and thus did not consider fetal termination. MAIN OUTCOME MEASURES: Standardized measures of depressive disorder and current psychiatric symptoms, as well as questions about emotional reactions to multifetal pregnancy reduction. RESULTS: Reduction patients who were pregnant or postpartum at the time of the interview (n = 34) were no more likely than pregnant or postpartum controls (n = 34) to report episodes of depression or high psychiatric symptom levels. The same proportion (14.7%) of both reduction patients and controls with a successful pregnancy outcome met criteria for an episode of major depressive disorder occurring during the 9 months before the interview. In contrast, the 8 reduction patients who spontaneously aborted the entire pregnancy and the 10 controls who spontaneously aborted reported significantly higher rates of the full depressive syndrome. CONCLUSIONS: Multifetal pregnancy reduction is experienced as stressful and distressing. However, when pregnancy outcome is successful, the medical intervention does not put women at significant risk for affective illness or elevated levels of psychiatric symptoms.

Abortion, Spontaneous↗
PubMed1991

Multifetal pregnancy reduction: a Belgian experience.

Multifetal pregnancy reductions were performed during the first trimester of pregnancy in 26 patients. Transabdominal intrathoracic KC1 injections were performed in 23 cases, and transcervical aspirations in 3 cases. There were 4 miscarriages (15%) during the second trimester, 18 pregnancies ended in 33 births, 4 pregnancies are going on uneventfully and are beyond 32 weeks. There was no maternal morbidity related to the procedure; fetal morbidity has been mild.

Abortion, Induced↗
PubMed1999

Multifetal pregnancy reductions of triplets to twins: comparison with nonreduced triplets and twins.

OBJECTIVE: Multifetal pregnancy reduction has been shown to improve survival rates in high-order multifetal pregnancies (>/=4). There is, however, some controversy as to whether multifetal pregnancy reduction improves pregnancy outcomes of triplets reduced to twins. The purpose of this study was to evaluate this issue by comparing outcomes of triplet gestations undergoing reduction to twins with outcomes of nonreduced twin gestations and expectantly managed triplet gestations. STUDY DESIGN: The study included 143 triplet pregnancies that underwent reduction to twins over a 10-year period at a single center. These were compared with 12 nonreduced triplet pregnancies from the Wayne State University Perinatal Database and with 2 groups of twin pregnancies: 605 from the Wayne State University Perinatal Database and 207 from the Quest Diagnostics Database. RESULTS: The miscarriage rate for expectantly managed triplets was 25%, compared with 6.2% for triplets reduced to twins. This rate was similar to the rates for both groups of nonreduced twins: 5.8% (Quest) and 6.3% (Wayne State University). Severe prematurity occurred in 25% of nonreduced triplets compared with 4. 9% of twins after reduction. This rate was also similar to that of nonreduced twins: 7.7% (Quest) and 8.4% (Wayne State University). The mean gestational age at delivery for expectantly managed triplets (32.9 +/- 4.7 weeks) was significantly shorter than for triplets reduced to twins (35.6 +/- 3.1 weeks). By comparison, nonreduced twins had a mean gestational age at delivery of 35.8 +/- 3.9 weeks for Quest and 34.4 +/- 3.6 weeks for Wayne State University. Mean birth weights were significantly lower in expectantly managed triplets as compared with triplets undergoing reduction to twins (1636 +/- 645 g vs 2381 +/- 602 g, respectively). Nonreduced twins had a mean birth weight of 2254 +/- 653 g for Quest and 2123 +/- 634 g for Wayne State University. Pregnancy loss rates, mean length of gestation, and mean birth weight did not vary significantly between triplets who underwent reduction to twins and nonreduced twins. CONCLUSIONS: Reduction of triplets to twins significantly reduces the risk for prematurity and low birth weight and may also be associated with a reduction in overall pregnancy loss. This suggests that multifetal pregnancy reduction of triplets to twins is a medically justifiable procedure not only from an actuarial viewpoint but also from the ethical perspective of supporting patients' autonomy and respect for patients' individual circumstances.

Abortion, Spontaneous↗