MULTIFETAL PREGNANCY REDUCTION IN SWEDEN UTILIZATION RATE AND PREGNANCY OUTCOME (1986-1992)

All departments of Obstetrics and Gynecology, as well as all private c linics in Sweden offering assisted conception, were surveyed by means of a questionnaire to determine the utilization rate and outcome of mu ltifetal pregnancy reduction (MFR) for the period 1 January 1986 to 30 June 1992. The response rate was 100%. Multifetal reduction was perfo rmed in 26 women, giving an average utilization rate of 1/7 multiple b irths of three or more for the entire period. Of the various technique s used, intracardiac or intrathoracic injection of a potassium chlorid e solution was predominant. The experience of each center with multife tal reductions varied between one and six procedures. In this series, the overall complete pregnancy loss was 27% (n=7). In 73% (n=19) of wo men the pregnancy continued to delivery. One fetus died in utero in th e second trimester, one child died from a subtentorial hemorrhage peri natally, and one child had a malformation of the right foot and hand. It seems necessary to limit MFR to a few centers in Sweden in order to maintain and increase the experience of the operators involved, and t o decrease the fetal loss rate associated with the procedure. However, the ultimate goal is to make these procedures unnecessary when method s of avoiding excessive ovulation are refined and by limiting the numb er of replaced embryos in IVF-treatment.