Outcome of early versus late multifetal pregnancy reduction.
Multifetal pregnancy reduction (MPR) is an accepted method of reducing complications of triplet pregnancies and higher-order multifetal pregnancies. Eighty-three pregnancies that underwent early (68 weeks) transvaginal MPR were compared with 125 pregnancies that underwent late (11-14 weeks) transabdominal MPR. Rates of pregnancy loss, preterm delivery, gestational diabetes and hypertensive disorders were similar among both groups. Early MPR was associated with a lower risk for small for gestational age newborns (6.5% versus 19.2%; P = 0.034; OR 0.32; 95% CI 0.11 to 0.92) and a higher risk for single-fetus loss (6% versus 0.8%; P = 0.041; OR 10.58; 95% CI 1.1 to 101.94). Preterm delivery rates seemed to be similar between the two groups. In MPR from triplets, an apparent benefit was observed for early MPR in preterm deliveries before 37 weeks, whereas, in MPR from high-order pregnancies, a benefit was observed for late MPR in deliveries before 32 weeks. Perinatal outcomes of twin pregnancies after early and late MPR seem to be grossly similar. Optimal timing for multifetal reduction depends on other factors, namely, the selectivity of the procedure and patient's preference.
IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel. Electronic address: jigalh@hotmail.com.
Jigal
J
Haas
IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Eran
E
Barzilay
IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Ariel
A
Hourvitz
IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Jehoshua
J
Dor
IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Shlomo
S
Lipitz
IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Yoav
Y
Yinon
IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
Mor
M
Shlomi
IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, 4428164, Kfar Saba, Israel; Sackler School of Medicine,Tel-Aviv University, Israel; Department of Obstetrics and Gynecology, Assuta Medical Center, Tel Aviv, Israel.
Adrian
A
Shulman
D000022:Abortion, Spontaneous; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects / Q000379:methods*; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors
abdominal fetal reduction; multifetal pregnancy reduction; perinatal outcome; transvaginal fetal reduction