Reduction of multifetal gestation to twins: is it always possible to attain natural outcomes?
Abstract
Purpose: The aim of this study was to evaluate effects of transabdominal fetal reduction on pregnancy outcomes.
Material and Methods: Women with multifetal gestation whose pregnancies were reduced to twins were compared with spontaneous twins and assisted reproduction twins. The main outcome measures were the duration of pregnancy, premature labor and delivery rates, complication rates during pregnancy, birth weight, APGAR scores, neonatal intensive care unite admission rates, and delivery routes.
Results: 380 twin deliveries followed up at our institution between years 2007-2014 were enrolled. All data concerning perinatal outcomes were compared among three groups. twins conceived spontaneously (group 3, n=165) and via IVF (group 1, n=117) along with IVF conceived high order pregnancies wherein embryo reduction was implemented (group 2, n=49). The duration of pregnancy, the rate of premature and the rate of overall pregnancy associated complications were all favorable in group 1 rather than group 2. As well, the mean birth weight and APGAR scores at 1st and 5th minutes were all found to be lower in group 2 than in group 1.
Conclusion: The results emphasize embryo reduction should be acknowledged as a salvage procedure due to high risk of complications in embryo reduced high-order pregnancies. Embryo reduction yields results comparable to twins conceived via IVF yields poorer results compared to spontaneously conceived twins.
Keywords
Multifetal Pregnancy,Embryo Reduction,Assisted Reproductive Technology
References
- Multiple gestation pregnancy. The ESHRE Capri Workshop Group. Hum Reprod. 2000;15:1856–64.
- Elster N. Less is more: the risks of multiple births. The Institute for Science, Law, and Technology Working Group on Reproductive Technology. Fertil Steril. 2000;74:617–23.
- Luke B, Brown MB. Maternal morbidity and infant death in twin vs triplet and quadruplet pregnancies. Am J Obstet Gynecol. 2008;198:e1-10.
- Antsaklis A, Anastasakis E. Selective reduction in twins and multiple pregnancies. J Perinat Med. 2011;39:15–21.
- Berkowitz RL, Lynch L, Stone J, Alvarez M. The current status of multifetal pregnancy reduction. Am J Obstet Gynecol. 1996;174:1265–72.
- Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH. Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod. 2006;21:1912–7.
- Bergh C, Möller A, Nilsson L, Wikland M. Obstetric outcome and psychological follow-up of pregnancies after embryo reduction. Hum Reprod. 1999;14:2170- 5.
- Devine PC, Malone FD. Maternal complications associated with multiple pregnancy. Clin Obstet Gynecol. 2004;47:227-36
- Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update. 2005;11:575-93.
- Pinborg A, Loft A, Schmidt L, Langhoff Ross J, Andersen AN. Maternal risks and perinatal outcome in a Danish national cohort of 1005 twin pregnancies: the role of in vitro fertilization. Acta Obstet Gynecol Scand. 2004;83:75-84
