1ST-TRIMESTER TRANSABDOMINAL MULTIFETAL PREGNANCY REDUCTION - A REPORT OF 200 COMPLETED CASES

OBJECTIVE: Multifetal pregnancy reduction has been proposed as a way t o reduce the risk of preterm delivery in women who conceive three or m ore fetuses. This communication presents the outcome of 200 consecutiv e multifetal pregnancies in which reduction to a smaller number of fet uses was accomplished. STUDY DESIGN: All of the procedures were perfor med in the first trimester by the transabdominal injection of potassiu m chloride into the thoraces of those fetuses that underwent feticide. All of the pregnancies have been completed and outcome data have been obtained in every case. RESULTS: At the time of the procedure 88 wome n had triplets, 89 had quadruplets, 16 had quintuplets, and 7 had from 6 to 9 fetuses. These pregnancies were reduced to 189 sets of twins, 5 sets of triplets, and 6 singletons. Reductions to triplets were done at the patient's request, and reductions to singletons were only done for medical indications. There were no cases of chorioamnionitis or o ther maternal complications attributable to the procedure. A total of 181 women were delivered of one or more live infants after 24 weeks' g estation, and 19 (9.5%) lost all of their fetuses before that time. Th e mean gestational age for all women delivered after 24 weeks was 35.7 weeks. The mean gestational age at delivery varied inversely with the initial number of fetuses, from 36.1 weeks for women who presented wi th triplets to 33.8 weeks for those who had 6 or more fetuses, and thi s trend was statistically significant. Sixteen of the 19 complete preg nancy losses occurred >4 weeks after the reduction procedure had been performed. The loss rates were 7.9% for those who presented with 3 or 4 fetuses, 12.5% for those with 5, and 42.9% for those with greater-th an-or-equal-to 6. This trend was statistically significant. Two neonat es died in the first week of life and one died at 10 months of age as a consequence of the sequelae of severe prematurity. Only two survivin g infants have shown evidence of chronic morbidity related to early de livery, and all of the others are developing normally. CONCLUSION: The incidence of intrauterine growth retardation was not increased over t hat anticipated in a population of twins.