Pregnancy Outcomes and Nursing Care in a Large Cohort of Multiple Pregnancy Cases Undergoing Transvaginal Multifetal Pregnancy Reduction

Abstract

Assisted reproductive techniques (ART) frequently result in multiple pregnancy, which in some cases poses a danger to the mother and may reduce fetal health and take-home baby rate. These adverse outcomes may be mitigated by transvaginal pregnancy reduction, but the perioperative nursing care related to good outcome has not been reported in large cohorts. This study therefore analyzed the pregnancy outcomes of twin and triplet pregnancies following early transvaginal multifetal pregnancy reduction, and summarized the experiences of perioperative nursing care. A total of 204 twin or triplet pregnancies conceived by ART who underwent transvaginal multifetal pregnancy reduction during gestational week 7 to 8 were retrospectively analyzed. Main outcome measures included operation success rate as well as rates of spontaneous abortion, preterm delivery, and cesarean section. Birth weight, gestational age at delivery, and take-home baby rate were also analyzed. The success rate of multifetal reduction was 100% with no perioperative complications. Pregnancy outcome after multifetal pregnancy reduction was satisfactory, with a take-home baby rate of 76.9% for twin-to singleton, 89.5% for triplet-to-twin reduction, and 92.3% for triplet-to singleton reduction. Perioperative nursing procedures critical for good outcome included facilitation of routine preoperative tests for surgical contraindications, pre- and intra-operative stress and anxiety counseling, disinfection and flushing of the vagina and perineum, inspection of aspiration equipment, postoperative management of diet, and education on postoperative signs of abnormality. In conclusion, multifetal reduction achieved satisfactory pregnancy outcomes. Efficient nursing care during the perioperative period is one of the most important factors for improved outcome following multifetal pregnancy reduction.