title: International, collaborative experience of 1789 patients having multifetal pregnancy reduction: a plateauing of risks and outcomes.
abstract: OBJECTIVE
  To develop the most up-to-date, complete data base of multifetal pregnancy reduction (MFPR) from cases, and to provide the best counseling for couples with multifetal pregnancies.
  
  
  METHODS
  From nine centers in five countries, 1789 completed MFPR cases were collected and outcomes evaluated. Pregnancy losses were defined as through 24 weeks and deliveries categorized in groups of 25-28, 29-32, 33-36, and 37 or more weeks.
  
  
  RESULTS
  Overall, the pregnancy loss rate was 11.7% but varied from a low of 7.6% for triplets to twins and increased with each additional starting number to 22.9% for sextuplets or higher. Early premature deliveries (25-28 weeks) were 4.5% and varied with starting number. Loss rates by finishing number were highest for triplets and lowest for twins, but gestational age at delivery was highest for singletons.
  
  
  CONCLUSIONS
  Multifetal pregnancy reduction has been shown to be a safe and effective method to improve outcome in multifetal pregnancies. Outcomes are worse with higher-order gestations and support the need for continued vigilance of fertility therapy.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, MI 48201, USA.
authors.forename: M I
authors.initials: MI
authors.lastname: Evans
authors.forename: M
authors.initials: M
authors.lastname: Dommergues
authors.forename: R J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: J D
authors.initials: JD
authors.lastname: Goldberg
authors.forename: L
authors.initials: L
authors.lastname: Lynch
authors.forename: I E
authors.initials: IE
authors.lastname: Zador
authors.forename: R J
authors.initials: RJ
authors.lastname: Carpenter
authors.forename: I
authors.initials: I
authors.lastname: Timor-Tritsch
authors.forename: B
authors.initials: B
authors.lastname: Brambati
authors.forename: K H
authors.initials: KH
authors.lastname: Nicolaides
authors.forename: Y
authors.initials: Y
authors.lastname: Dumez
authors.forename: A
authors.initials: A
authors.lastname: Monteagudo
authors.forename: M P
authors.initials: MP
authors.lastname: Johnson
authors.forename: M S
authors.initials: MS
authors.lastname: Golbus
authors.forename: L
authors.initials: L
authors.lastname: Tului
authors.forename: S M
authors.initials: SM
authors.lastname: Polak
authors.forename: R L
authors.initials: RL
authors.lastname: Berkowitz
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology*; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015337:Multicenter Studies as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D018570:Risk Assessment; D014310:Triplets; D014427:Twins