MULTIFETAL PREGNANCY REDUCTION - A CONSECUTIVE SERIES OF 61 CASES

Objective The effect of selective fetocide on the course of 61 multiple pregnancies. Design An observational study. Setting A tertiary centre. Subjects 61 women whose pregnancies included 37 triplets, 18 quadruplets, 5 quintuplets and 1 heptuplet; 97% followed IVF or the induction of ovulation. The aim of the procedure in most cases was to obtain twins. Interventions Selective reduction was performed before 13 weeks gestation under general anaesthesia, using either a transcervical (n = 26) or transabdominal approach (n = 35). Fifty-four twins, 4 singletons and 3 triplets were obtained after the procedure. Main outcome measure Preterm labour rate. Results The rate of unplanned fetal loss was 13% and was related to the number of suppressed embryos (P<0.05). The preterm labour rate was 56.6%, the mean gestation at delivery was 35.6 weeks. Seven deliveries were before 32 weeks and led to all neonatal deaths. A comparison with published data suggested that fetal reduction reduced the rate of preterm labour in high multiple pregnancies; in 24 twin pregnancies obtained after reduction of triplets there was probably a gain of 2 weeks gestation. Severe growth retardation occurred in 13%. The perinatal mortality rate was 10.8%. Conclusions Selective termination reduces but does not prevent early preterm labour. The procedure is of value in pregnancies with more than 3 fetuses and should be considered carefully for triplet pregnancies.