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  • Title: First-trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases.
    Author: Berkowitz RL, Lynch L, Lapinski R, Bergh P.
    Journal: Am J Obstet Gynecol; 1993 Jul; 169(1):17-21. PubMed ID: 8333448.
    Abstract:
    OBJECTIVE: Multifetal pregnancy reduction has been proposed as a way to reduce the risk of preterm delivery in women who conceive three or more fetuses. This communication presents the outcome of 200 consecutive multifetal pregnancies in which reduction to a smaller number of fetuses was accomplished. STUDY DESIGN: All of the procedures were performed in the first trimester by the transabdominal injection of potassium chloride into the thoraces of those fetuses that underwent feticide. All of the pregnancies have been completed and outcome data have been obtained in every case. RESULTS: At the time of the procedure 88 women had triplets, 89 had quadruplets, 16 had quintuplets, and 7 had from 6 to 9 fetuses. These pregnancies were reduced to 189 sets of twins, 5 sets of triplets, and 6 singletons. Reductions to triplets were done at the patient's request, and reductions to singletons were only done for medical indications. There were no cases of chorioamnionitis or other maternal complications attributable to the procedure. A total of 181 women were delivered of one or more live infants after 24 weeks' gestation, and 19 (9.5%) lost all of their fetuses before that time. The mean gestational age for all women delivered after 24 weeks was 35.7 weeks. The mean gestational age at delivery varied inversely with the initial number of fetuses, from 36.1 weeks for women who presented with triplets to 33.8 weeks for those who had 6 or more fetuses, and this trend was statistically significant. Sixteen of the 19 complete pregnancy losses occurred > 4 weeks after the reduction procedure had been performed. The loss rates were 7.9% for those who presented with 3 or 4 fetuses, 12.5% for those with 5, and 42.9% for those with > or = 6. This trend was statistically significant. Two neonates died in the first week of life and one died at 10 months of age as a consequence of the sequelae of severe prematurity. Only two surviving infants have shown evidence of chronic morbidity related to early delivery, and all of the others are developing normally. CONCLUSION: The incidence of intrauterine growth retardation was not increased over that anticipated in a population of twins. During the period of September 5, 1986 to November 27, 1991, 200 consecutive women with 3 or more fetuses underwent transabdominal multifetal pregnancy reduction in the Perinatal Unit of the Mount Sinai Medical Center, New York City. These patients were principally referred by infertility specialists from all over the eastern US. All of the procedures were performed in the first trimester by the transabdominal injection of potassium chloride into the thoraces of those fetuses that underwent feticide. All of the pregnancies had been completed, and outcome data had been obtained in every case. At the time of the procedure, 88 women had triplets, 89 had quadruplets, 16 had quintuplets, 7 had from 6-9 fetuses. Reductions resulting in triplets were done at the patient's request, and reductions resulting in singletons were only done for medical indications. There were no cases of chorioamnionitis or other maternal complications attributable to the procedure. 181 women were delivered of 1 or more live infants after 24 weeks gestation, and 19 lost all of their fetuses before that time. The mean gestational age for all women delivered after 24 weeks was 35.7 weeks. The mean gestational age at delivery varied inversely with the initial number of fetuses, from 36.1 weeks for women who presented with triplets to 33.8 weeks for those who had 6 or more fetuses. This trend was statistically significant by linear more than 4 weeks after the reduction procedure had been performed. The loss rates were 7.9% for those who presented with 3 or 4 fetuses, 12.5% for those with 5, and 42.9% for those with or= 6. This trend was statistically significant. 2 neonates died in the first week of life, and 1 died at 10 months of age because of the sequelae of severe prematurity. Only 2 surviving infants showed evidence of chronic morbidity related to early delivery, and all of the other 351 infants were developing normally.
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