Genetic analysis prior to selective fetal reduction in multiple pregnancy: technical aspects and clinical outcome.
Multiple pregnancies resulting from ovarian stimulation are at a higher risk of carrying at least one fetus affected by Mendelian or chromosomal anomalies, the incidence of which is directly related to the order of multiples. Genetic analysis before fetal reduction was offered to both high- and low-risk pregnant women carrying two or more fetuses after ovulation induction. Chorionic villus sampling (CVS) and fetal reduction were achieved by transabdominal needling. The use of short-term culture, the polymerase chain reaction and fresh tissue enzymatic analyses have made it possible for genetic diagnosis to be available in a few days. A total of 100 patients had multifetal pregnancy reduction performed by a single operator; all of them completed pregnancy and none was lost at follow-up. The total fetal loss before 24 weeks was 7% and no statistically significant relationship was found with the final number of fetuses and CVS. Perinatal losses (3.9%) were only present in the series with a final number of two fetuses. Pregnancy duration and birthweight were significantly higher in singletons than in twins, but were not related to CVS. The rate of chromosomal disorders was higher (7.2%) in the study series than in singleton pregnancies not undergoing fetal reduction. Diagnostic error due to incorrect sampling was reported in 1.5% of cases. These data support fetal reduction as a valuable strategy to improve the outcome of multiple pregnancy. The outcome of pregnancies reduced to singletons was significantly better than of those reduced to twins, and was not related to CVS.(ABSTRACT TRUNCATED AT 250 WORDS)
Brambati
B
B
First Institute of Obstetrics and Gynecology, University of Milan, Italy.
Tului
L
L
Baldi
M
M
Guercilena
S
S
D000328:Adult; D015193:Chorionic Villi Sampling / Q000379:methods; D002869:Chromosome Aberrations / Q000175:diagnosis; D025063:Chromosome Disorders; D005314:Embryonic and Fetal Development / Q000235:genetics; D005260:Female; D005817:Genetic Counseling; D006801:Humans; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011272:Pregnancy, Multiple / Q000235:genetics*; D011296:Prenatal Diagnosis