Multifetal pregnancy reduction in cases of threatened abortion of triplets

Abstract

Objective: To investigate the course of pregnancy and fetal outcome after first-trimester multifetal pregnancy reduction (MFPR) in patients with triplet pregnancies and uterine bleeding. Design: Case series of patients with threatened triplet pregnancies considered for MFPR. Setting: Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tiqva, Israel. Patient(s): Forty-two patients with triplet pregnancies and first-trimester uterine bleeding. Intervention(s): At 10–15 weeks’ gestation, MFPR with intracardiac injection of potassium chloride was performed. The procedures were performed 7–10 days after cessation of bleeding (9–13 weeks) or in the presence of minimal uterine bleeding (14–15 weeks). In patients with heavy uterine bleeding, MFPR was postponed. Main Outcome Measure(s): Early- and late-pregnancy complications related to the procedure, pregnancy outcome, and fetal survival. Result(s): Performance of MFPR at 14–15 weeks was associated with a higher abortion rate (38.5%), lower mean gestational age at delivery (30.6 weeks), and lower mean twin birth weight (1,376 ± 218 g and 1,014 ± 202 g) than was performance of MFPR at 10–13 weeks (18.8%, 33.2 weeks, and 1,720 ± 245 g and 1,596 ± 170 g, respectively). Abortion occurred in four of the five patients with moderate to heavy uterine bleeding who did not undergo MFPR; the fifth patient gave birth prematurely at 28 weeks, and two of the newborns died. Conclusion(s): Pregnancy outcome and fetal mortality and morbidity in triplet pregnancy after MFPR are directly correlated with duration and amount of first-trimester bleeding.