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Second-trimester multifetal pregnancy reduction facilitates prenatal diagnosis before the procedure
1Lis Maternity Hospital, Tel Aviv Sourasky Medical Center; The Chaim Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. gevae@obgyn.ucsf.edu
Objective:
To evaluate the pregnancy outcome of selective second-trimester multifetal pregnancy reduction (MFPR) compared to first-trimester MFPR.
Design:
Cohort analysis.
Setting:
In Vitro Fertilization Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Patient(S):
The study groups comprised 38 and 70 patients who underwent selective second-trimester MFPR (group 1) and first-trimester MFPR (group 2) at mean gestational ages of 19.7 +/- 3.3 weeks and 11.7 +/- 0.7 weeks, respectively.
Intervention(S):
Ultrasonographically guided intracardiac injection of potassium chloride (KCl) solution.
Main Outcome Measure(S):
Pregnancy outcome and obstetric complications.
Result(S):
No statistically significant difference was found between group 1 and group 2 regarding mean gestational age at delivery (35.4 +/- 3.4 weeks and 35.9 +/- 3.1 weeks, respectively); mean birth weight (2,318.9 +/- 565.7 g and 2, 138.1 +/- 529.4 g); and the incidence of obstetric complications. These complications included pregnancy loss (5.2% and 15.7%), pregnancy-induced hypertension (0 and 10%), discordancy (12% and 18. 4%), intrauterine growth restriction (0 and 40%), and gestational diabetes (0% and 6%). However, the rate of all pregnancy complications was lower among second-trimester MFPR patients.
Conclusion(S):
Selective second-trimester MFPR is associated with favorable perinatal outcome and may facilitate detection of structural and chromosomal anomalies before the procedure and selective reduction of the affected fetus.