Multifetal pregnancy reduction: modification of the technique and analysis of the outcome.
OBJECTIVE
To modify the technique of multifetal pregnancy reduction and to study the outcome of reduced twins in comparison with nonreduced twins and high-order multiple gestations.


METHODS
Prospective controlled study.


METHODS
The Egyptian IVF-ET Center, Cairo.


METHODS
Seventy-five patients with high-order multiple pregnancies resulting from assisted reproduction. Controls were 40 nonreduced twin pregnancies and 22 high-order multiple gestations.


METHODS
Transvaginal ultrasonically guided multifetal pregnancy reduction was performed. The first 30 cases were done using KCl as a cardiotoxic agent. The modified technique was used for the last 45 cases at an earlier gestational age (approximately 7 weeks) by eliminating the use of KCI and by aspirating the embryonic parts.


METHODS
Miscarriage rate, gestational age at delivery, birth weight, and pregnancy complications.


RESULTS
Using the modified technique, the miscarriage rate was 8.8% and 41 patients delivered between 32 and 39 weeks of gestation (mean+/-SD, 36.9+/-2.45 weeks). The mean (+/-SD) birth weight was 2,450.51+/-235.44 g. The miscarriage rate, fetal wastage rate, mean gestational age, and mean birth weight were similar in reduced and nonreduced twins and were significantly better than in nonreduced triplets and quadruplets.


CONCLUSIONS
The modified technique of multifetal pregnancy reduction significantly improved outcomes, which were similar to those of nonreduced twins resulting from assisted reproduction and significantly better than those of nonreduced triplets and quadruplets.
Mansour
R T
RT
The Egyptian IVF-ET Center, Cairo. ivf@intouch.com
Aboulghar
M A
MA
Serour
G I
GI
Sattar
M A
MA
Kamal
A
A
Amin
Y M
YM
D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D014427:Twins