First-trimester multifetal pregnancy reduction: Evaluation of technical aspects and risks from 2,756 cases in the literature

Objective: To evaluate the technical aspects, efficacy and safety of first- trimester multifetal pregnancy reduction in the management of multifetal pr egnancies, an analysis of the international literature on first-trimester m ultifetal pregnancy reduction was made. Materials: Thirty-three studies wer e selected from an international review of the literature. Total fetal loss rate, risk of fetal loss after the procedure with the different techniques and gestational age at delivery were the main parameters studied. The Krus kal-Wallis test and Mann-Whitney test were used for statistical analysis. R esults: 2,756 multifetal pregnancy reductions were performed (2,145 transab dominal, 363 transcervical, and 248 transvaginal procedures). Total fetal l oss rates were different: 16.7% for the transabdominal, 24.8% for the trans cervical and 10.9% for the transvaginal procedure (p = 0.03). The risk of f etal loss was 12% for the transabdominal, 20% for the transcervical, and 10 % for the transvaginal approach at less 24 weeks of gestation (p = 0.04). T here was no difference for the gestational age at the time of the procedure , the initial and final number of embryos, and the gestational age at deliv ery. Conclusion: Because the transvaginal approach seems to be the safer pr ocedure, surgeons may opt for it. The transcervical approach has a high fet al loss rate and should be excluded.