title: Spontaneous abortions in couples declining multifetal pregnancy reduction.
abstract: Multifetal pregnancy reduction (MFPR) has clearly improved the outcomes of multifetal gestations. Several recent reports have also suggested improved outcomes in nonreduced cases, but there have been methodologic concerns about the denominators, i.e. have all cases been included and is there a 'hidden mortality' of unknown lost cases. Here we assessed the outcome of patients telephoning to discuss MFPR, but who chose not to have the procedure. Over a 3-year period, 446 patients had MFPR by one operator. Nineteen patients chose not to have the procedure. There were 11 preterm births, 1 term delivery, and 5 spontaneous losses (7 of 17) prior to 24 weeks, a loss rate of 35%. Two patients delivering triplets had a loss of 1 fetus/neonate. These data suggest that the loss rates of nonreduced pregnancies may be higher than generally thought, making the improvements with MFPR even bigger than generally realized.
authors.affiliation: Department of Obstetrics and Gynecology and Human Genetics, MCP Hahnemann University, Philadelphia, PA 19102-1192, USA. fetaldxr@drexel.edu
authors.forename: Mark I
authors.initials: MI
authors.lastname: Evans
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Ayoub
authors.forename: Alex G
authors.initials: AG
authors.lastname: Shalhoub
authors.forename: Baruch
authors.initials: B
authors.lastname: Feldman
authors.forename: Yuval
authors.initials: Y
authors.lastname: Yaron
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000706:statistics & numerical data*; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000706:statistics & numerical data