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Multifetal pregnancy reduction in cases of threatened abortion of triplets
J Shalev1, I Meizner, R Mashiach
1Department of Obstetrics and Gynecology, Rabin Medical Center-Beilinson Campus, Petah-Tiqva, Israel.
Objective:
To investigate the course of pregnancy and fetal outcome after first-trimester multifetal pregnancy reduction (MFPR) in patients with triplet pregnancies and uterine bleeding.
Design:
Case series of patients with threatened triplet pregnancies considered for MFPR.
Setting:
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tiqva, Israel.
Patient(S):
Forty-two patients with triplet pregnancies and first-trimester uterine bleeding.
Intervention(S):
At 10-15 weeks' gestation, MFPR with intracardiac injection of potassium chloride was performed. The procedures were performed 7-10 days after cessation of bleeding (9-13 weeks) or in the presence of minimal uterine bleeding (14-15 weeks). In patients with heavy uterine bleeding, MFPR was postponed.
Main Outcome Measure(S):
Early- and late-pregnancy complications related to the procedure, pregnancy outcome, and fetal survival.
Result(S):
Performance of MFPR at 14-15 weeks was associated with a higher abortion rate (38.5%), lower mean gestational age at delivery (30.6 weeks), and lower mean twin birth weight (1,376+/-218 g and 1,014+/-202 g) than was performance of MFPR at 10-13 weeks (18.8%, 33.2 weeks, and 1,720+/-245 g and 1,596+/-170 g, respectively). Abortion occurred in four of the five patients with moderate to heavy uterine bleeding who did not undergo MFPR; the fifth patient gave birth prematurely at 28 weeks, and two of the newborns died.
Conclusion(S):
Pregnancy outcome and fetal mortality and morbidity in triplet pregnancy after MFPR are directly correlated with duration and amount of first-trimester bleeding.