DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20164654

Outcomes of transvaginal multifetal pregnancy reduction without injecting potassium chloride

Devika Gunasheela, Sneha Rao, Geethika Jain, Anitha GS

Abstract


Background: Assisted reproductive technologies and the use of fertility drugs have significantly increased the prevalence of multiple pregnancy in last three decades. Various techniques and routes have been studied so far regarding fetal reduction to achieve healthy viable pregnancy. The current study aims to study different outcomes of multifetal pregnancy reduction without injecting potassium chloride.

Methods: Total 57 patients were studied from October 2011 to November 2012 at our centre. 28 were higher order pregnancies who consented for fetal reduction and 29 were nonreduced twins as control group. It was a prospective comparative study. Fetal reduction was done transvaginally between 8-12 weeks by intracardiac puncture followed by manual aspiration of embryonic parts till asystole. Use of KCl was avoided. The most easily accessible sac was chosen for reduction. All were reduced to twins. Reduction to singleton and selective reduction of anomalous fetus were removed from the study as it could have created a bias in the comparison. The primary outcomes like miscarriage, post procedure complications, mean gestational age at delivery, preterm delivery, mean birth weight were studied. The outcomes of reduced twins were compared with that of nonreduced twins. The various secondary outcomes like IUGR, take home baby rate, neonatal morbidity, mortality, maternal morbidity and mortality, associated obstetric complications were studied.

Results: Both groups were comparable with respect to age and parity. The average gestation of fetal reduction was 9.46 weeks. Abortion rate was 17.9% (n=5) in reduced group which was statistically significant. 4 patients were lost to follow up. There were no statistically significant differences with regard to cesarean section rate, preterm delivery, mean birth weight, mean gestational delivery between two groups. No incidence of IUGR in the series. One baby died in the control group, none in reduced group. Take home baby rate 79.1%. Overall the antenatal and post-operative complications were higher in control group than in reduced but it was not statistically significant.

Conclusions: Fetal reduction is a feasible option for triplets and higher orders multiple pregnancies. Use of KCl is not mandatory for multifetal pregnancy reduction. It is best avoided as there are increased rates of preterm labour and PPROM. There is increase in abortion rate after multifetal pregnancy reduction in comparison to nonreduced twins. So couple should be counseled about the probability of losing the entire pregnancy. The obstetric and neonatal outcomes of reduced and nonreduced twins are comparable, thus fetal reduction as a procedure is not adding any extra risk on pregnancy outcome.


Keywords


Potassium chloride, Transvaginal multifetal pregnancy

Full Text:

PDF

References


Berkowitz RL, Lynch L. The current status of multifetal pregnancy reduction. Am J Obstet Gynecol. 1996;174:1265-72.

Berkowitz RL, Lynch L, Lapinski R. First trimester transabdominal multifetal pregnancy reduction: A report of two hundred completed cases. Am J Obstet Gynecol. 1993;169:17-21.

Committee on Ethics, multifetal pregnancy reduction and selective fetal termination. Am coll of Obstetricians and Gynecologists, Washington. 1-3 ACOG- Committee Opinion no 94. 1991.

Iberico G, Navarro J, Blasco L, Simon C, Pellicer A, Remohi J. Embryo reduction of multifetal pregnancies following assisted reproduction treatment: A modification of the trans vaginal ultrasound – guided technique L, Simon C, Pellicer A, Remohi J. embryo reduction of multifetal pregnancies following assisted reproduction treatment: a modification of the trans vaginal ultrasound – guided technique. Hum reprod. 2000;15(10):2228-33.

Roze RJ, Tschupp MJ, Arvis PH. Interruption selective de grossesses et malformations embryonnaires des extremites. J.Gynecol Obstet Biol Reprod. 1989;18:673-7.

Tabsh KM. Transabdominal multifetal preganacy reduction: Report of 40 cases. Obstetric Gynecology. 1990;75:739-41.

Tabsh KM, Theroux NL. Genetic amniocentesis following multifetal pregnancy reduction to twins: assessing the risk. Prenat Diagn. 1995;15:221-3.

Lee JR, Ku SY, Jee BH, Suh CS, Kim KC. Pregnancy outcomes of different methods for multifetal pregnancy reduction: A comparative study. J Korean Med Sci. 2008;23(1):111-6.

Riffenburg RH. Statistics in Medicine, second edition, Academic press. 2005:85-125.

Suresh KP, Chandrasekhar S. Sample Size estimation and Power analysis for Clinical research studies. Journal Human Reproduction Science. 2012;5(1):7-13.

Evans MI, Richard L. Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol. 2001;184: 97-103.

Mansour RT, Aboulghar MA, Serour GI. Multifetal pregnancy reduction: Modification of the technique and analysis of the outcome. Fertil Steril. 1999;71:380-4.

Lee JR, Ku SY, Jee BH, Suh CS, Kim KC. Pregnancy outcomes of different methods for multifetal pregnancy reduction: A comparative study. J Korean Med Sci. 2008;23(1):111-6.

Coffler MS, Kol S, Drugan A, Itskovitz-Eldor J. Early transvaginal embryo aspiration: a safer method for selective reduction in high order multiple gestations. Hum Reprod. 1999;14:1875-8.

Itskovitz-Eldor J, Drugan A, Levron J. Transvaginal embryo aspiration - a safe method for selective reduction in multiple pregnancies. Fertil. Steril. 1992;58:351-5.

Lipitz S, Frenkel Y, Watts C. Higher order multiple gestation: Management and outcome. Obstet and Gynecol. 1990;76:215-8.

Sebire NJ, Sherod C, Abbas A. Preterm delivery and growth restriction in multifetal pregnancies reduced to twins. Human Reprod. 1997;12:173-5.

Yaron Y, Bryant-Greenwood PK, Dave N, Molenhauer JS, Kramer RL. Multifetal pregnancy reductions of triplets to twins: comparison with nonreduced triplets and twins. Am J Obstet Gynecol. 1999;180:1268-71.

Boulot P, Hedon B, Pelliccia G. Effects of selective reduction in triplet gestation. Fertil Steril. 1993:497-503.

Melgar CA, Rosenfeld DL, Rawlinson K, Greenberg M. Perinatal outcome after multifetal reduction of twins compared with multiple gestation. Obstet Gynecol. 1991;78:763-7.

RP Porreco. Multifetal reduction of triplets and pregnancy outcome. Obstet Gynecol. 1991;78:335-9.

Yousef H. Pregnancy outcome after multifetal reduction via early transvagianl embryo aspiration: Mansura fertility care unit experience. Middle East Fertility Society Journal. 2007;12(3):168-73.