title: First-trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases.
abstract: OBJECTIVE
  Multifetal pregnancy reduction has been proposed as a way to reduce the risk of preterm delivery in women who conceive three or more fetuses. This communication presents the outcome of 200 consecutive multifetal pregnancies in which reduction to a smaller number of fetuses was accomplished.
  
  
  METHODS
  All of the procedures were performed in the first trimester by the transabdominal injection of potassium chloride into the thoraces of those fetuses that underwent feticide. All of the pregnancies have been completed and outcome data have been obtained in every case.
  
  
  RESULTS
  At the time of the procedure 88 women had triplets, 89 had quadruplets, 16 had quintuplets, and 7 had from 6 to 9 fetuses. These pregnancies were reduced to 189 sets of twins, 5 sets of triplets, and 6 singletons. Reductions to triplets were done at the patient's request, and reductions to singletons were only done for medical indications. There were no cases of chorioamnionitis or other maternal complications attributable to the procedure. A total of 181 women were delivered of one or more live infants after 24 weeks' gestation, and 19 (9.5%) lost all of their fetuses before that time. The mean gestational age for all women delivered after 24 weeks was 35.7 weeks. The mean gestational age at delivery varied inversely with the initial number of fetuses, from 36.1 weeks for women who presented with triplets to 33.8 weeks for those who had 6 or more fetuses, and this trend was statistically significant. Sixteen of the 19 complete pregnancy losses occurred > 4 weeks after the reduction procedure had been performed. The loss rates were 7.9% for those who presented with 3 or 4 fetuses, 12.5% for those with 5, and 42.9% for those with > or = 6. This trend was statistically significant. Two neonates died in the first week of life and one died at 10 months of age as a consequence of the sequelae of severe prematurity. Only two surviving infants have shown evidence of chronic morbidity related to early delivery, and all of the others are developing normally.
  
  
  CONCLUSIONS
  The incidence of intrauterine growth retardation was not increased over that anticipated in a population of twins.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, NY 10029.
authors.forename: R L
authors.initials: RL
authors.lastname: Berkowitz
authors.forename: L
authors.initials: L
authors.lastname: Lynch
authors.forename: R
authors.initials: R
authors.lastname: Lapinski
authors.forename: P
authors.initials: P
authors.lastname: Bergh
mesh_terms: D000028:Abortion, Induced; D000013:Congenital Abnormalities; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D011189:Potassium Chloride; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011272:Pregnancy, Multiple
chemical_list: D011189:Potassium Chloride