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Spontaneous abortions in couples declining multifetal pregnancy reduction
Mark I Evans1, Ronald J Wapner, Melissa A Ayoub
1Department of Obstetrics and Gynecology and Human Genetics, MCP Hahnemann University, Philadelphia, PA 19102-1192, USA. fetaldxr@drexel.edu
Fetal Diagnosis and Therapy
|October 24, 2002
Summary
Multifetal pregnancy reduction (MFPR) improves outcomes. However, nonreduced pregnancies have higher loss rates than previously thought, highlighting the significant benefits of MFPR for multifetal gestations.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Reproductive Medicine
Background:
- Multifetal pregnancy reduction (MFPR) has improved outcomes in multifetal gestations.
- Recent reports suggest improved outcomes in nonreduced cases, but with methodologic concerns regarding case inclusion and potential 'hidden mortality'.
Purpose of the Study:
- To assess the pregnancy outcomes of patients who discussed MFPR but opted against the procedure.
- To evaluate the actual loss rates in nonreduced multifetal pregnancies.
Main Methods:
- Retrospective analysis of 19 patients who chose not to undergo MFPR over a 3-year period.
- Tracking of pregnancy outcomes including preterm births, term deliveries, and spontaneous losses.
Main Results:
- Among 19 patients not undergoing MFPR, there were 11 preterm births, 1 term delivery, and 5 spontaneous losses before 24 weeks.
- This represents a loss rate of 35% (7 of 17) in the early gestational period for nonreduced pregnancies.
- Two triplet gestations experienced a single fetal/neonatal loss.
Conclusions:
- The spontaneous loss rate in nonreduced multifetal pregnancies may be significantly higher than commonly recognized.
- These findings underscore the substantial benefits and improved outcomes associated with MFPR in managing multifetal gestations.