Cases Of Multifetal Pregnancy Reduction Research Articles

Transabdominal ultrasound-guided multifetal pregnancy reduction in 10 cases of monkeys.

Intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) in nonhuman primates, e.g. rhesus and cynomolgus monkeys, has been widely used in researches of reproductive and developmental biology, and the success rate has been improved significantly. However, unwanted multiple pregnancy occurs frequently during the ICSI-ET in monkeys, most of which leads to miscarriages. To improve the birth rate of pregnancies and to safeguard health of host and baby monkeys, multifetal pregnancy reduction (MPR) is necessary. In this study, a total of 10 monkeys with multiple pregnancies received MPR through transabdominal ultrasound-guided potassium chloride injection into beating hearts of selective fetuses. To assess MPR efficiency, 31 monkeys with normal singleton pregnancies and 25 monkeys with twin pregnancies without MPR were used as controls. The aim of the reduction is to keep only one fetus, no matter twin or triplet pregnancy originally. Our results show that six cases of MPR were successful and all of them retained single fetus. Moreover, about 1 month (30.2±1.2 days) of gestation is a better timing for MPR than later stage (50.7±1.9 days). We also found that the remaining fetuses developed normally with full-term gestation and normal birth weight. In conclusion, transabdominal ultrasound-guided potassium chloride injection is a safe and effective MPR method for monkeys with multiple pregnancies.

Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR)

This study was undertaken to report on the outcome of multifetal pregnancy reduction in the most up-to-date largest single center experience with this procedure, and compare the outcome to the first 1000 cases performed at the same institution. 1000 consecutive cases of multifetal pregnancy reduction performed at the Mount Sinai Medical Center between the years 1999-2006 were identified. Pregnancy outcomes were retrieved from a large database as well as chart review. Differences in means and proportions were evaluated by analysis of variance, chi-square, Cochran-Armitage test for trend or 2-tailed Fisher exact test as appropriate. Outcomes were available on 841 cases, for a follow-up rate of 84.1%; 95.2% of patients delivered after 24 weeks, for a complete loss rate of 4.7%. There was a significant trend toward decreasing loss rates with decreasing starting numbers. Mean gestational age at delivery was later, and birthweights greater, for reduction to singletons vs twins. Loss rates after multifetal pregnancy reduction have remained stable at 4.7%. The lowest loss rate occurred in the patients reducing from twins to a singleton (2.1%). Reduction to a singleton was also associated with higher birthweights and lower rates of preterm deliveries.

Evolving trends in 2000 cases of multifetal pregnancy reduction: a single-center experience

The purpose of this study was to examine changes in multifetal pregnancy reduction (MPR) procedures in 2000 cases and to evaluate evolving trends within the last 1000 MPRs. Two thousand patients who underwent MPR were identified. Data were collected from a computerized database. Comparisons were made between the first 1000 patients (group 1) and the second 1000 patients (group 2). In addition, changing trends within group 2 were also analyzed. Differences in proportions were evaluated by chi-square test and Fisher's exact test, as appropriate. There was a significant difference in the starting and finishing number of fetuses and a significant increase in the use of chorionic villus sampling before MPR in group 2 vs group 1 (43.7% vs 1.5%; P < .0001). The incidence of monochorionicity was significantly higher in group 2 (5.7%), compared with group 1 (2.1%; P < .001). Recent trends in MPR demonstrates significant increases in overall reductions to a singleton fetus, the use of chorionic villus sampling, and the presence of monochorionicity.

Evolving trends in 2,000 cases of multifetal pregnancy reduction

JOANNE STONE, ANDREA MATHO, RICHARD BERKOWITZ, VICTORIA BELOGOLOVKIN, KEITH EDDLEMAN, Mount Sinai School of Medicine, Obstetrics or Gynecology, New York, New York, Mount Sinai School of Medicine, OBGYN, New York, New York, Columbia Presbyterian Medical Center, New York, New York, Mount Sinai School of Medicine, Obstetrics and Gynecology, New York, New York, Mount Sinai School of Medicine, Obstetrics, Gynecology and Reproductive Science, New York, New York OBJECTIVE: To examine changes in MPR procedure in 2,000 cases, and to evaluate evolving trends within the last 1,000 MPR’s. STUDY DESIGN: A computerized database was used to identify 2,000 consecutive patients undergoing MPR. Data was collected from the database and chart review. Comparisons were made between the first 1,000 (Group 1) and the 2nd 1,000 MPRs (Group 2). In addition, changing trends within Group 2 were also analyzed by dividing the patients into chronological groups of 200. Differences in proportions were evaluated by chi-square test and Fisher’s Exact as appropriate. RESULTS: There was a significant difference in starting and finishing numbers of fetuses between the 2 groups (p!0.0001) (Tables 1 and 2). A significant increase was seen in chorionic villus sampling (CVS) was seen in group 2 vs. Group 1 (43.7% vs. 1.5%, p! 0.0001). Within group 2, there was a significant trend toward an increasing number of patients undergoing CVS, with 25.5% of patients in the first group of 200 vs. 69.5% in the last group of 200 undergoing CVS pre-MPR, p!0.001.The incidence of monochorionic twins/triplets was significantly higher in Group 2 (5.7%) compared to group 1 (2.1%), p!0.001. Similarly, within Group 2, there was a significant increase in the incidence of monochorionicity (Table 3). CONCLUSION: Recent trends in MPR demonstrate significant increases in overall reductions to a singleton, reductions from twins to a singleton, utilization of CVS prior to MPR and presence of a monochorionic twin or triplet pair within a higher order multiple gestaion.

Two hundred ninety consecutive cases of multifetal pregnancy reduction: Comparison of the transabdominal versus the transvaginal approach

The purpose of this study was to compare the performance of the transabdominal versus the transvaginal route for the multifetal pregnancy reductions. Two hundred ninety consecutive cases of multifetal pregnancy reduction were reviewed. Two hundred three reductions (70.0%) were done transabdominally; 75 cases (25.9%) were done transvaginally, and 12 cases (4.1%) used both routes. The indications for the transvaginal route were extreme obesity, abdominal scars, or if the lower fetus could not be reached transabdominally. Two hundred seventy-one women were delivered of live born babies after 24 weeks (group 1). Nineteen cases had pregnancy losses </=24 weeks (group 2). The complete pregnancy loss rate was 6.5% (19/290 cases). Total pregnancy loss rates of multifetal pregnancy reduction were 3.5% (7/203 reductions) for the transabdominal route and 13.3% (10/75 reductions) for the transvaginal route ( P = .004). Overall pregnancy losses were 4.8% for starting with twins, 6.6% for starting with triplets, 1.8% for starting with quadruplets, 14.3% for starting with quintuplets, and 14.3% with starting numbers of >/=6 fetuses. For finishing numbers, total pregnancy losses were 5.1% for ending with a singleton infant, 6.6% for ending with twins, and 0% for ending with triplets. Significant differences in complete pregnancy loss were observed between transabdominal and transvaginal routes for starting with triplets (2.7% for transabdominal versus 16.7% for transvaginal; P = .006) and for finishing with a single fetus (0% for transabdominal versus 20% for transvaginal; P < .004). The multifetal pregnancy reduction success rate was higher with the transabdominal route compared with the transvaginal route. Significant differences in favor of the transabdominal route were observed for starting with triplets or finishing with a single fetus. The transvaginal route should be reserved only for cases in which the transabdominal approach is hard or impossible to perform. The performance of the procedure at 12 to 13 weeks of gestation enables structural evaluation of the fetuses before reduction.

Multifetal Pregnancies: Evolution of Methods of Initiation and Impact of REI Certification for Patients Seeking Reduction

Objective: Multifetal pregnancy as a result of ovulation induction (OI) and assisted reproductive technologies (ART) correlate with Board certification in reproductive endocrinology and infertility (REI). Design: Retrospective chart analysis of 304 patients referred to Wayne State University (WSU) and Thomas Jefferson University (TJU) for multifetal pregnancy reduction (MFPR) from March 1986 to January 1995 compared to 275 patients referred from January 1 to December 31, 2000 at MCP Hahnemann University. Material and Methods: Chart review for fetal number, pregnancy generation (OI or ART) and physician REI Board certification from the American Board of Specialties Obstetrics and Gynecology. Information was available on 296 of 304 patients studied in the 1986–1995 WSU cohort and 275 patients studied from the MCP Hahnemann 2000 cohort. Results: Analysis of 296 multifetal pregnancies at WSU and TJU for REI Board status showed non-REI Board-certified (NREI) physicians generated 174 pregnancies with quadruplets or more compared to 122 quadruplets or more by REI Board-certified physicians. Board certification did not impact quadruplet or more rates for OI or ART (p < 0.368). Of 275 patients with triplets or more at MCP Hahnemann, 156 (56.7%) were from ARTs versus 41.2% from 1986–1995 (χ² = 13.1, p < 0.001). Quintuplets or more decreased from 18.5 to 9.7% (χ² = 8.3, p = 0.004), and for REIs from 22.1 to 9.6% (χ² = 4.7, p < 0.01), while 14.4% of cases coming from non-REIs had quintuplets versus 9.6% from REIs (p = NS). Conclusions: Cases of MFPR from ARTs have risen, while percentage of cases with quintuplets have fallen in half. We found no difference in quintuplets between REIs and non-REIs overall, but REI quintuplets fell significantly, and NREI has not.

P357: Two hundred and ninety consecutive cases of multifetal pregnancy reduction (MFPR) at the New York university medical center

Objective: To describe pregnancy and epidemiological characteristics of the MFPR at our institution. Materials and methods: 290 consecutive cases of MFPR were performed during the years 08/1998–02/2002. The transvaginal route (TVS) was chosen in cases of extreme obesity, patient with abdominal scars and if the fetus in the lowest sac had to be reduced and could not be reached transabdominally (TAS). Prophylactic antibiotics was given. 271 cases were defined as successful by delivery of liveborn babies after 24 postmenstrual weeks of gestation (Group 1). 19 cases had pregnancy losses at, or before 24 weeks (Group 2). Epidemiological as well as pregnancy characteristics were compared. Results: The total pregnancy loss rate was 6.5% (19/290). The loss rate of MFPR by TAS was 3.45% (7/203) and by TVS 13.3 (10/75). Pregnancy losses in relation to starting numbers were was: 4.6% for starting with twins, 7.1% for triplets, 3.3% for quadruplets, 13.6% for quintuplets and 9% for starting number of 6 and above. Pregnancy losses in relation to finishing numbers were: 7.3% for ending with a singleton, 6.3% for twins and 0% for triplets. Parity was higher among Group 1 compared to Group 2 (1.2 ± 0.5 vs. 0.7 ± 1.4, respectively). This difference was statistically significant (p = 0.0001). In Group 1, there was a higher rate of transabdominal reductions compared to Group 2 (72.4% vs. 36.8%). This difference was statistically significant (p < 0.008). No statistical difference was found between the two groups regarding to selective reduction (10% vs. 16%, p = 0.31) respectively. Conclusions: 1. The success rate was higher when the procedure was done abdominally and the patient was multiparous. 2. No significant trend was seen as far as starting or finishing numbers were concerned. 3. The transvaginal route should be reserved only for cases in which the transabdominal approach is hard or impossible to perform.

A single center experience with 1000 consecutive cases of multifetal pregnancy reduction

Objective: Multifetal pregnancy reduction (MPR) is a technique developed to reduce the risks of a multifetal pregnancy. The objective of this article was to report the outcome of MPR in the largest single-center experience to date. Study Design: A computerized database was used to determine the outcome of 1000 consecutive cases patients undergoing transabdominal MPR between the years 1986 and 1999. Outcomes analyzed included pregnancy loss rates, preterm delivery rates, and mean birth weights. Results: The complete pregnancy loss rate was 5.9%, whereas the unintended pregnancy loss rate was 5.4%. The loss rate was 9.5% in the first 200 cases and remained stable at 4.5% to 6.0% over the next 800 cases. The loss rate was lowest with starting numbers of two fetuses (2.5%), remained stable for three, four, and five fetuses, and increased to 12.9% with starting numbers of six fetuses or greater. Loss rates were similar with a finishing number of one or two (3.5 % and 5.5%, respectively) but were highest for a finishing number of three (16.7%). Analysis of birth weights showed a linear decline with increasing starting and finishing numbers. Mean gestational age of delivery for finishing numbers of one, two, and three fetuses was 37.9, 35.3, and 33.5 weeks. Conclusion: Unintended loss rates associated with MPR have stabilized at 5.4%. Loss rates are highest with starting numbers of six or more fetuses, but did not differ for starting numbers of three, four, or five fetuses. Gestational age of delivery for finishing numbers of one, two, and three fetuses are similar to that of nonreduced pregnancies. (Am J Obstet Gynecol 2002;187:1163-7.)

59 A single center experience with 1000 consecutive cases of multifetal pregnancy reduction (MPR)

59 A single center experience with 1000 consecutive cases of multifetal pregnancy reduction (MPR)

Multifetal pregnancy reduction: A review of the world results for the period 1993–1996

The objective of this work was to evaluate the outcome of multifetal pregnancy reduction and to provide an analysis of the ethical dilemmas associated with its application. The study design was based on data on over 1400 completed pregnancies that underwent multifetal pregnancy reduction as reported in the world literature during 1993–1996. The results were: A total of 1453 completed cases of multifetal pregnancy reduction are presented. The total survival rate was estimated to be 87.7%, resulting in a total pregnancy loss rate of 12.3%. The lowest survival rate is found to be in higher-order pregnancies of five or more fetuses (75.2%), whereas pregnancy loss rate seems to be similar for quadruplets, triplets and twins that underwent reduction (11.3%, 8.3% and 13.6%, respectively). A 33.3% of the total pregnancy loss rate occurred within four weeks from the procedure, whereas 66.7% occurred after the four weeks but at 24 weeks of gestation or earlier. The mean gestational age at delivery was estimated to be 33 weeks for pregnancies reduced to triplets, 35.8 weeks for those reduced to twins and 36.9 weeks for singletons, with 5% delivering at less than 28 weeks and 9.6% at 29–32 weeks. We conclude that multifetal pregnancy reduction has been established as an efficient and safe way to improve outcome of multifetal gestations, especially those with four or more fetuses and likely of triplets. As the experience from the procedure increases, it seems that reduction of triplets to twins can be offered to patients with satisfactory results. The reduction to singletons has not yet been established and is being performed only when medical indications exist. Prenatal genetic diagnosis should become an integral part of counselling on multiple pregnancy. Physicians should take whenever possible measures designed to prevent high multiple birth pregnancies. We also note that although multifetal pregnancy reduction improves significantly the outcome of multiple pregnancies, several ethical dilemmas arising from its application are still under dispute.