Selective reduction in multifetal pregnancies: Technical and psychological aspects

Abstract

To evaluate efficiency and safety of a very early transvaginal selective reduction procedure in multifetal pregnancies.Prospective study.Obstetric and Gynecology Department, University of Paris VI.Twenty-two patients with multifetal pregnancies: 14 triplets, 8 quadruplets, and 1 quintuplet.Selective embryonic reduction was performed at 7 weeks of amenorrhea under general anesthesia by transvaginal embryo puncture and aspiration. Two embryos were left in place.Pregnancy outcome (immediate or delayed complication, term of delivery, newborns) and psychological impact.No complication occurred. The 22 patients now have delivered at 36.5 weeks of amenorrhea, on average giving birth to 44 neonates with no congenital malformation. If the procedure generates anxiety, it is nevertheless perceived as necessary for the successful outcome of the pregnancy.Early mechanical transvaginal embryo reduction performed at 7 weeks of amenorrhea, leaving two embryos is, in our opinion, a simple and safe procedure with no affect on remaining fetuses. It is necessary when there are four or more embryos, and it should also be proposed for triplets. In these circumstances, patients saw reduction as a necessary procedure.This study sought to evaluate the efficiency and safety of a very early transvaginal selective reduction procedure in multifetal pregnancies. The Obstetric and Gynecology Department of the University of Paris VI was the site of this prospective study which included 22 patients--14 sets of triplets, 8 sets of quadruplets, and 1 set of quintuplets. Selective embryonic reduction was performed at 7 weeks of amenorrhea under general anesthesia by transvaginal embryo puncture and aspiration. 2 embryos were left in place. The main outcomes measured were pregnancy outcome (immediate or delayed complications, term of delivery, newborns), and psychological impact. No complications occurred and the 22 patients have now delivered at 36.5 weeks of amenorrhea, giving birth, on the average to 44 neonates with no congenital malformations. If the procedure has generated anxiety, it has nevertheless been perceived as necessary for the successful outcome of these pregnancies. Early mechanical transvaginal embryo reduction performed at 7 weeks amenorrhea and leaving 2 embryos intact is, according to these authors, a simple and safe procedure with no effects on the remaining fetuses. It is essential when there are 4 or more embryos and it should be proposed for triplets. Under these circumstances, the patients also saw the necessity of the procedure.