Selective termination of anomalous fetuses in multifetal pregnancies: two hundred cases at a single center.
OBJECTIVE
The objective of this study was to summarize the outcome of 200 selective termination (ST) procedures performed at a single center.


METHODS
Two hundred patients underwent ST at the Mt Sinai Medical Center from 1986 to 2000. The following data were collected for each patient: indication for the ST, gestational age (GA) at the time of the procedure, starting and ending number of fetuses, which fetus(es) underwent ST (presenting vs nonpresenting), and GA at delivery or at spontaneous pregnancy loss less than 24 weeks.


RESULTS
ST was performed on 164 sets of twins, 32 triplets, and 4 quadruplets. Median GA at the time of ST was 19.6 weeks. The presenting fetus was terminated in 91 (45.5%) cases. There were 8 (4%) unintended pregnancy losses less than 24 weeks, 4 of 164 (2.4%) in twins, 4 of 32 (12.5%) in triplets, and none of the 4 in quadruplets. The median GA at delivery in the remaining 190 patients was 37.1 weeks. One hundred sixty (84.2%) patients were delivered at >or=32 weeks' gestation.


CONCLUSIONS
ST at our institution has an overall unintended pregnancy loss rate of 4%. The loss rate is almost 5-fold higher in patients carrying 3 or more fetuses (11.1%) than for those carrying twins (2.4%). ST is a reasonable alternative in multifetal pregnancies in which 1 or more fetuses have a significant abnormality.
Eddleman
Keith A
KA
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, Mt Sinai Medical Center, New York, NY, USA.
Stone
Joanne L
JL
Lynch
Lauren
L
Berkowitz
Richard L
RL
D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology; D000013:Congenital Abnormalities / Q000196:embryology* / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects; D011783:Quadruplets; D014310:Triplets; D014427:Twins