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Reduction of multifetal gestation to twins: is it always possible to attain natural outcomes?

Year 2016, Volume: 41 Issue: 3, 485 - 490, 30.09.2016
https://doi.org/10.17826/cukmedj.237487

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.

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
  • Lynch L, Berkowitz RL, Chitkara U, Alvarez M. First-trimester transabdominal multifetal pregnancy reduction: a report of 85 cases. Obstet Gynecol. 1990;75:735–8.
  • Coffler MS, Kol S, Drugan A, Itskovitz-Eldor J. Early transvaginal embryo aspiration: a safer method for selective reduction in high order multiple gestations. Hum Reprod. 1999;14:1875-8.
  • Evans MI, Berkowitz RL, Wapner RJ, Carpenter RJ, Goldberg JD, Ayoub MA et al. Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol. 2001;84:97-103.
  • Stone J, Ferrara L, Kamrath J, Getrajdman J, Berkowitz R, Moshier Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR). Am J Obstet Gynecol. 2008;199:e1-4.
  • Kuhn-Beck F, Moutel G, Weingertner AS, Kohler M, Hornecker F, Hunsinger MC et al. Fetal reduction of triplet pregnancy: one or two?. Prenat Diagn. 2012;32:122–6.

Çoğul gebeliklerin ikize indirgenmesi: doğal sonuçları elde etmek her zaman mümkün müdür?

Year 2016, Volume: 41 Issue: 3, 485 - 490, 30.09.2016
https://doi.org/10.17826/cukmedj.237487

Abstract

Amaç: Bu çalışmanın amacı transabdominal fetal redüksiyonun gebelik sonuçlarına olan etkisini araştırmaktır. Gereç ve Yöntem: Redüksiyon yapılan ikiz gebelikler ile spontan ikiz ve yardımcı üreme teknikleri (IVF) ile oluşan ikiz gebelikler karşılaştırıldı. Gebelik süreleri, pematür doğum ve doğum oranları, gebelikteki komplikasyonlar, doğum ağırlığı, APGAR skoru, yenidoğan yoğun bakımda yatış oranı ve doğum şekli açısından karşılaştırıldı. Sonuç: 2007-2014 yılları arasında takibi yapılan 380 ikiz doğum çalışmaya alındı. Perinatal sonuçlar ile ilgili tüm veriler üç grup arasında karşılaştırıldı. Spontan ikiz gebelikler (grup 3, n=165) ve IVF ile oluşan ikiz gebelikler (grup 1, n=117) ve redüksiyon sonrası ikiz gebelik devam edenler (grup 2, n=49). Gebelik süresi, erken doğum ve gebelikle ilişkili komplikasyonlar grup 1’deki hastalarda grup 2’ye göre anlamlı olarak iyiydi. Bunun yanı sıra doğum ağırlığı, APGAR 1.ve 5.dakika skorları grup 2’de grup 1’e gore daha düşüktü. Tartışma: Embriyo redüksiyonu yüksek riskli komplikasyonları olmasına ragmen çoğul gebeliklerde önerilmektedir. Embriyo redüksiyonu, IVF ile olan ikiz gebelikler spontan ikiz gebelikler ile karşılaştırıldığında sonuçları daha olumsuz olarak saptanmıştır.

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
  • Lynch L, Berkowitz RL, Chitkara U, Alvarez M. First-trimester transabdominal multifetal pregnancy reduction: a report of 85 cases. Obstet Gynecol. 1990;75:735–8.
  • Coffler MS, Kol S, Drugan A, Itskovitz-Eldor J. Early transvaginal embryo aspiration: a safer method for selective reduction in high order multiple gestations. Hum Reprod. 1999;14:1875-8.
  • Evans MI, Berkowitz RL, Wapner RJ, Carpenter RJ, Goldberg JD, Ayoub MA et al. Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol. 2001;84:97-103.
  • Stone J, Ferrara L, Kamrath J, Getrajdman J, Berkowitz R, Moshier Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR). Am J Obstet Gynecol. 2008;199:e1-4.
  • Kuhn-Beck F, Moutel G, Weingertner AS, Kohler M, Hornecker F, Hunsinger MC et al. Fetal reduction of triplet pregnancy: one or two?. Prenat Diagn. 2012;32:122–6.
There are 15 citations in total.

Details

Subjects Health Care Administration
Journal Section Research
Authors

Tuncay Yüce This is me

Mehmet Murat Seval This is me

Erkan Kalaeat This is me

Batuhan Özmen This is me

Acar Koç This is me

Publication Date September 30, 2016
Published in Issue Year 2016 Volume: 41 Issue: 3

Cite

MLA Yüce, Tuncay et al. “Reduction of Multifetal Gestation to Twins: Is It Always Possible to Attain Natural Outcomes?”. Cukurova Medical Journal, vol. 41, no. 3, 2016, pp. 485-90, doi:10.17826/cukmedj.237487.