Multifetal pregnancy reduction: modification of the technique and analysisof the outcome

Objective: To modify the technique of multifetal pregnancy reduction and to study the outcome of reduced twins in comparison with nonreduced twins and high-order multiple gestations. Design: Prospective controlled study. Setting: The Egyptian IVF-ET Center. Cairo. Patient(s): Seventy-five patients with high-order multiple pregnancies resu lting from assisted reproduction. Controls were 40 nonreduced twin pregnanc ies and 22 high-order multiple gestations. Intervention(s): Transvaginal ultrasonically guided multifetal pregnancy re duction was performed. The first 30 cases were done using KCl as a cardioto xic agent. The modified technique was used for the last 45 cases at an earl ier gestational age (approximately 7 weeks) by eliminating the use of KCl a nd by aspirating the embryonic parts. Main Outcome Measure(s): Miscarriage rate, gestational age at delivery, bir th weight, and pregnancy complications. Result(s): Using the modified technique, the miscarriage rate was 8.8% and 41 patients delivered between 32 and 39 weeks of gestation (mean +/- SD, 36 .9 +/- 2.45 weeks). The mean (+/- SD) birth weight was 2,450.51 +/- 235.44 g. The miscarriage rate, fetal wastage rate, mean gestational age, rind mea n birth weight were similar in reduced and nonreduced twins and were signif icantly better than in nonreduced triplets and quadruplets. Conclusion(s): The modified technique of multifetal pregnancy reduction sig nificantly improved outcomes, which were similar to those of nonreduced twi ns resulting from assisted reproduction and significantly better than those of nonreduced triplets and quadruplets. (Fertil Steril(R) 1999:71:380-4. ( C) 1999 by American Society for Reproductive Medicine.)