Multifetal pregnancy reduction: comparison of obstetrical results with spontaneous twin gestations

Abstract

Thirty-two multifetal pregnancies were reduced to twin gestations. Our control group was composed of 32 spontaneous twin gestations. The comparison of these two groups did not show that the procedure altered obstetrical results as far as duration of gestation, birth weight and rate of dismaturity are concerned.

PIP: An obstetrician performed multifetal pregnancy reduction (MFPR) around 10 weeks gestation in 32 women admitted to the Academic Hospital Erasme in Brussels, Belgium (some of the women had undergone in vitro fertilization and embryo transfer), between December 1985 and December 1990, and compared their outcomes with those of 32 women who had spontaneous twin gestations between 1988 and 1990. The multifetal pregnancies comprised 15 triplet, 12 quadruplet, and 4 quintuplets pregnancies and 1 sextuplet pregnancy. MFPRs included 2 transcervical aspirations and 30 injections of potassium chloride into the uterine cavity. 2 miscarriages occurred after MFPR in women who had had triplet pregnancies (9 and 13 weeks gestation). All 32 control mothers and the remaining 30 cases delivered live infants (64 and 60, respectively). The mean birth weight of MFPR cases born at less than 34 weeks gestation was considerably higher than the controls born at less than 34 weeks gestation (1568 g vs. 1275 g, p = .015, for all MFPRs; 1672 g vs. 1275 g, p = .036, for MFPRs whose mothers had had at least 4 fetuses [high order MFPRs]). 45% of control infants were small for gestational age compared to 40% of MFPR infants, but this difference was insignificant. No statistical association between gestational age at birth and groups existed, even when the MFPR groups were divided into total MFPRs and high order MFPRs. No maternal morbidity occurred in either group. Another study indicated that the outcomes for triplet pregnancies are the same for MFPR as they are for triplet pregnancies managed expectantly. Therefore, the results of this Belgian study and the other study led the Belgian researchers to consider MFPR to be a valuable option for high order multifetal pregnancies.