Follow-up of pregnancies, infants, and families after multifetal pregnancy reduction.
OBJECTIVE
To evaluate the course of multifetal pregnancies and also the long-term pediatric and psychosocial follow-up of surviving offspring and their parents after selective reduction.


METHODS
Follow-up study.


METHODS
University hospital and subject's homes.


METHODS
Twenty-one couples with high-order multiple pregnancies resulting from infertility treatment were referred from all over the Netherlands. A total of 36 infants (15 twins and 2 triplets) were included in the follow-up.


METHODS
Pregnancy reduction by transabdominal approach at a median of 11 (9 to 13) weeks gestation. One assessment took place between the age of 9 months and 6 years after delivery.


METHODS
Pregnancy outcome, health of the infants, and psychosocial impact upon their parents after infertility treatment and the multifetal pregnancy reduction.


RESULTS
Abortion within 4 weeks after pregnancy reduction did not occur in this series. Six infants (13.7%) died perinatally. Two infants (4.4%) died at the ages of 12 days and 3 months, respectively. Early preterm delivery was the cause of death in all cases. The development of the infants was appropriate to gestational age and birth weight. At follow-up, 14 couples disclosed at the time they were unaware of the risks and the consequences of infertility treatment. Nine couples indicated they had feelings of guilt after pregnancy reduction. These feelings, however, were not disclosed at the time of the interviews, during which none of the families showed either regret or distress about their decision. Two couples only occasionally experienced some grief and mourning reactions for the reduced fetuses.


CONCLUSIONS
Pregnancy reduction is an acceptable option in the case of excessive multifetal conceptions after infertility treatment regimes. There are no adverse effects on either the infants and their families provided that the procedure is carefully planned and performed and the couples are given full support both before and after the procedure.
Kanhai
H H
HH
Department of Obstetrics, University Medical Centre, Leiden, The Netherlands.
de Haan
M
M
van Zanten
L A
LA
Geerinck-Vercammen
C
C
van der Ploeg
H M
HM
Gravenhorst
J B
JB
D005260:Female; D005307:Fertilization in Vitro; D005500:Follow-Up Studies; D006117:Grief; D006167:Guilt; D006801:Humans; D007246:Infertility / Q000628:therapy; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000523:psychology; D011272:Pregnancy, Multiple