Effects Of Multifetal Pregnancy Reduction Research Articles

Multi-Fetal Reduction May Be the Better Choice for Multi-Fetal Pregnancies: A Cohort Study

Objective: The rate of multiple pregnancies increases the number of pregnancies conceived using assisted reproductive techniques. Although the studies indicate a positive effect of multi-fetal pregnancy reduction on pregnancy outcomes, procedure-associated miscarriages should be considered. Therefore, our study aimed to evaluate the outcomes of pregnancies that have undergone multi-fetal reduction and compare the pregnancies' outcomes without any intervention. Material and Methods: Patients from the Perinatology Clinic of Şanlıurfa Training and Research Hospital were selected between July 2017 and May 2021. The patients in the study group were divided into two groups: those with or without multi-fetal reduction. Obstetric outcomes of pregnancies were compared between the groups. Results: During this period, 95 gestations with three or more fetuses were applied to our clinic. Eighteen multi-fetal reduction procedures were performed because of multiple pregnancies. Reductions were performed from five to twins in one case, triplets to twins in ten, and quadruplets to twins in seven cases. Patients preferred to continue pregnancies without intervention in 6 quadruplets, one sextile, and 66 triplet pregnancies. Mean gestational age at birth in the intervention group was 34.43±0.40 (32-38) weeks, while in the non-intervened group, that was 30.46±0.48 (24-37) gestational weeks. Gestational age at birth was significantly lower in the non-intervention group. (p: 0.000029). Conclusion: Multi-fetal reduction is beneficial in preventing preterm delivery.

Differences in Fetal Growth, Discordancy, and Placental Pathology in Reduced versus Nonreduced Twins

This study evaluated the effect of multifetal pregnancy reduction on the incidence of small for gestational age (SGA) and discordance in reduced versus nonreduced twins and differences in placental pathology. A computerized ultrasound database was used to identify diamniotic-dichorionic twins who delivered at our institution. Reduced (n = 36) versus nonreduced twins (n = 243) were compared for differences in rates of SGA and discordancy (>or= 20%.) The groups were compared for differences in maternal and neonatal characteristics, as well as differences in placental pathology. Chi-square tests were used to compare differences in means. Stepwise logistic regression was used to adjust for potential confounders including placental pathology. The rate of SGA in either twin A or B remained nonsignificant after adjustment for the use of assisted reproductive technology and gestational age at delivery in the stepwise logistic model (odds ratio, 1.7 95%; confidence interval, 0.5, 5.2). The average discordance at delivery was 12.4% in reduced versus 11.4% in the nonreduced twins ( P = 0.54). We found no overall differences in placental pathology between the two groups. Reduced and nonreduced twins have no significant differences in SGA fetuses, growth discordancy, or placental pathology.

Differences in fetal growth, discordancy and placental pathology in reduced vs. non-reduced twins

To evaluate the effect of multifetal pregnancy reduction on the incidence of small-for-gestational age (SGA) and discordance in reduced vs non-reduced twins and to examine differences in placental pathology. A computerized ultrasound database was used to identify diamniotic-dichorionic twins who delivered at our institution. Reduced (n=36) vs non-reduced twins(n=243) were compared for differences in rates of SGA and discordancy (>20%). The groups were compared for differences in maternal and neonatal characteristics, as well as differences in placental pathology. Chi-square and stepwise logistic regression were used as appropriate. A comparison of maternal and neonatal characteristics are presented in Table 1. Reduced twins were not found to have a greater incidence of growth discordancy than non-reduced twins. However, there was a trend towards a higher incidence of SGA in reduced vs. non-reduced twins. We found no differences placental path between the 2 groups, p=0.49. Reduced and non-reduced twins have no significant differences in SGA fetuses, growth discordancy, placental pathology or other selected characteristics.Tabled 1MPR vs non MPRMPR twins (%) n=36Non-MPR twins (%) n=243p-valueAge (avg+/-SD)36.7 (4.7)33.2 (6.3)<0.01Parity≥9 (25)71 (29)0.47SGA A610.06SGA B850.33Discordacne20%≥19140.43Preeclampsia19130.31IVF8656<0.01 Open table in a new tab Tabled 1Path MPR vs non MPRPath A+BMPR twins (%) n=34Non-MPR twins (%) n=192Velamentous610Ischemia3850Abruption03Inflammation911 Open table in a new tab

The decreased rates of triplet births: Temporal trends and biologic speculations

Recent data from the US and from England and Wales demonstrate decreasing rates of higher-order multiple births and represent, for the first time, a striking change in trend when compared with the previous steep 4-fold increase since the early 1980s. However, the incidence of other multiples--twins--continued to escalate. The most probable reasons for this change are new embryo transfer guidelines and availability of multi-fetal pregnancy reduction procedures. Because actual numbers of higher-order multiples are by far lower than the number of twins, and because twins are predictably associated with significant perinatal morbidity and mortality, the implications of the ever-increasing multiple birth rates are no less alarming. As long as the incidence of twins is not reduced, the decreasing incidence of higher-order multiples, per se, does not herald the end of the epidemic of multiple births.

Pregnancy outcome after multifetal pregnancy reduction

Objective: To study the effects of multifetal pregnancy reduction (MFPR) as a means to reduce the adverse outcome of multiple gestations.Methods: This was a retrospective study evaluating the outcome of 334 multiple pregnancies after embryo reduction.Results: In 313 multiple pregnancies in which MFPR was performed before 15 weeks, the rates of miscarriage, preterm delivery < 33 weeks, preterm delivery < 36 weeks and total fetal loss were 9.12%, 13.33%, 38.60% and 16.25%, respectively, and median gestational age at delivery was 35 weeks. There was a significant correlation between miscarriage and the finishing number of fetuses. In 185 triplets reduced to twins, miscarriage, preterm delivery < 33 weeks, preterm delivery < 36 weeks and total fetal loss occurred in 8.25%, 11.18%, 40.59% and 15.41% of cases, respectively, and median gestational age at delivery was 36 weeks. In the subgroup of 32 reduced triplet pregnancies that also had second-trimester amniocentesis, the risk of miscarriage (3.13%) was not significantly different from that in the rest of the group. Among 21 twin pregnancies that had selective termination at or after 15 weeks, the risk of preterm delivery < 33 weeks was three times higher than in the group of 22 twin pregnancies with first-trimester procedures.Conclusion: MFPR resulted in at least one live neonate in 83.75% of cases and was effective in reducing the risks of pregnancy loss and severe prematurity in quadruplets and higher-order pregnancies. The risk of miscarriage increased with increasing finishing number of fetuses. In reduced triplets gestation was prolonged in comparison with average figures reported in the literature. In twin pregnancies selective termination in the first trimester carries a lower risk of severe preterm delivery and this emphasizes the need for first-trimester diagnosis.

Multifetal pregnancy reduction of triplet and higher-order multiple pregnancies to twins

This systematic review was performed to assess the effects of multifetal pregnancy reduction for women with triplet and higher-order multiple pregnancies on fetal loss, preterm birth, and perinatal and infant mortality and morbidity. From nonrandomized studies, multifetal pregnancy reduction seems to be an effective treatment option, with outcomes comparable to those obtained from twin pregnancies conceived spontaneously or after assisted reproductive techniques.

Midtrimester maternal serum screening after multifetal pregnancy reduction in pregnancies conceived by in vitro fertilization.

Data about the effect of multifetal pregnancy reduction on midtrimester maternal serum levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) are scarce and contradictory. Differing gestational ages at fetal reduction, transvaginal versus transabdominal needle insertion, and injection of different feticidal agents compound the analysis of published data. We examined clinical and laboratory data about 27 high-order gestations that were reduced to twins in the first trimester. Fetal reductions were performed transabdominally at 11.41 +/- 1.15 weeks' gestation by fetal intrathoracic injection of KCl, and maternal blood sampling was performed at 16.48 +/- 1.05 weeks. "Pseudo-risks" for singleton pregnancies were calculated by correcting serum analyte levels for twins. Twenty-four (88.9%) of 27 patients had maternal serum AFP levels above 2.0 MoM (mean, 4.60 +/- 3.48 MoM; range, 1.49-14.85 MoM), however, none of the newborns had structural anomalies. AFP serum levels did not correlate with the number of reduced fetuses or with adverse obstetric outcome. The mean hCG levels were 1.22 +/- 0.49 MoM (range, 0.14-2.47), and the mean uE3 levels were 1.15 +/- 0.31 MoM (range, 0.56-1.84). Based on maternal age alone, seven patients (25.9%) would have been offered amniocentesis for a term Down syndrome risk greater than 1:384, whereas combined risk calculations with hCG and uE3 levels resulted in 1 (3.7%) screen-positive case (P < 0.01).

Psychological reactions after multifetal pregnancy reduction: a 2-year follow-up study

This study had two objectives. Firstly we assessed the effects of multifetal pregnancy reduction on the mothers' emotional well-being and the relationship with the children during the 2 years following intervention. Secondly at 2 years we compared mothers who had a reduction with mothers who had not and had delivered triplets. The comparisons focused on the mothers' health and their relationship with the children. Women having had a reduction in two hospitals in Paris, between May 1992 and June 1993, were contacted just after intervention for a prospective study. In all, 18 women were included. At 1 and 2 years, 10 women participated. At 2 years, 10 additional women were included. The answers of these 20 mothers were compared to those of 11 consecutive mothers of 2 year old triplets, assessed by the same psychologist in a previous prospective study. Semi-structured interviews were conducted at home. The mothers' social characteristics, their parity, the children's condition at birth and 4 months were very similar between the reduction and triplet groups. One year after birth one-third of the women in the reduction group reported persistent depressive symptoms related to the reduction, mainly sadness and guilt. The others made medical and rational comments expressing no emotion. At 2 years all but two women seemed to have overcome the emotional pain associated with the reduction. The comparison with mothers of triplets indicated that the mothers' anxiety and depression, and difficult relationship with the children were less acute in the reduction group. These results presented some limitations, since a high number of women who miscarried or refused to participate in the follow-up were not assessed at 1 and 2 years. However, a majority of women who participated in the study 2 years after intervention seemed able to accept a multifetal pregnancy reduction to achieve parental goals.

Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations

OBJECTIVE: Our purpose was to evaluate effects of multifetal pregnancy reduction on pregnancy complications and birth weights of remaining twin fetuses compared with expectantly managed triplets and nonreduced twins. STUDY DESIGN: Medical records of 54 triplet pregnancies, 59 twin pregnancies resulting from multifetal pregnancy reduction, and 88 sets of twins conceived with assisted reproductive techniques and delivered at New York Hospital after 24 weeks were retrospectively reviewed. Birth weights were corrected for gestational age at delivery by use of a formula derived from composite standardized growth curves. Statistical analysis was performed with χ2 analysis and Student t test. RESULTS: Twins remaining after reduction and nonreduced twins were less likely to have preeclampsia than were triplets (14% and 23% vs 30%) and to be delivered before 36 weeks (39% and 27% vs 72%). They had birth weights that were >100 gm larger than those of triplets even when corrected for gestational age. Reduced twins were similar to nonreduced twins in all parameters studied. CONCLUSIONS: Multifetal pregnancy reduction results in pregnancy complications, gestational age, and birth weights closer to those of nonreduced twins than to expectantly managed triplets. (Am J Obstet Gynecol 1996;175:878-82.)

Maternal serum analyte levels after first-trimester multifetal pregnancy reduction

OBJECTIVE: Our purpose was to assess the effect of multifetal pregnancy reduction on maternal serum levels of analytes used for screening low-risk women for fetal chromosome abnormalities and neural tube defects. STUDY DESIGN: Peripheral blood samples were obtained between 15.0 and 20.9 weeks' gestation from 10 consecutive women who had undergone first-trimester multifetal pregnancy reduction. The samples were assayed for levels of α-fetoprotein, human chorionic gonadotropin, and unconjugated estriol. Analyte concentrations were interpreted within our maternal serum screening program. RESULTS: Levels of α-fetoprotein were significantly elevated in all samples. In each pregnancy levels of human chorionic gonadotropin and unconjugated estriol were consistent with the number of continuing gestations. CONCLUSIONS: First-trimester multifetal reduction does not alter second-trimester levels of human chorionic gonadotropin and unconjugated estriol. Further study is needed to determine whether these analytes could be used to screen pregnancies for fetal chromosome abnormalities after first-trimester multifetal reduction. (AM J OBSTET GYNECOL 1996;174:1072-4.)

The psychological effects of multifetal pregnancy reduction

To study the psychological effects of multifetal pregnancy reduction. Hour-long semistructured telephone interviews with both multifetal pregnancy reduction patients and control subjects. Forty-two multifetal pregnancy reduction patients were contacted within 1 year of undergoing the procedure. Forty-four control subjects had become pregnant after infertility evaluation or treatment but conceived only a single fetus or twins and thus did not consider fetal termination. Standardized measures of depressive disorder and current psychiatric symptoms, as well as questions about emotional reactions to multifetal pregnancy reduction. Reduction patients who were pregnant or postpartum at the time of the interview (n = 34) were no more likely than pregnant or postpartum controls (n = 34) to report episodes of depression or high psychiatric symptom levels. The same proportion (14.7%) of both reduction patients and controls with a successful pregnancy outcome met criteria for an episode of major depressive disorder occurring during the 9 months before the interview. In contrast, the 8 reduction patients who spontaneously aborted the entire pregnancy and the 10 controls who spontaneously aborted reported significantly higher rates of the full depressive syndrome. Multifetal pregnancy reduction is experienced as stressful and distressing. However, when pregnancy outcome is successful, the medical intervention does not put women at significant risk for affective illness or elevated levels of psychiatric symptoms.

The effect of multifetal pregnancy reduction on serum relaxin

To determine the effect of multifetal pregnancy reduction on circulating relaxin levels. Patients with multifetal pregnancies had relaxin levels determined on the day of multifetal pregnancy reduction, after the procedure, and late in pregnancy. Forty-eight women (26 presenting with three fetuses and 22 with four or more) were studied. All pregnancies followed some form of ovulation induction. All pregnancies (except for one, which was reduced to a singleton) were reduced to twins. Pre-procedure, post-procedure and late-pregnancy relaxin levels were significantly higher in the in vitro fertilization (IVF)-gamete intrafallopian transfer (GIFT) group compared with the human menopausal gonadotropin (hMG)-alone group (P < .05). The initial number of fetuses had no significant effect on relaxin levels. Although post-procedure relaxin levels were significantly lower than pre-procedure levels (P = .002), relaxin levels continued to decrease throughout pregnancy, as evidenced by even lower levels later on (P = .0001). Serum relaxin levels were significantly higher in the IVF-GIFT group than in the hMG-alone group, which probably reflects more aggressive ovulation induction in the former. Because relaxin levels continued to decrease throughout pregnancy, the difference observed between pre- and post-procedure levels are not considered to be due to the procedure itself.