Pregnancy outcome after multifetal pregnancy reduction

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine
• Perinatology

Background:

• Multiple gestations are associated with increased risks of adverse perinatal outcomes, including miscarriage and preterm delivery.
• Multifetal pregnancy reduction (MFPR) is a procedure to reduce the number of fetuses, aiming to improve pregnancy outcomes.

Purpose of the Study:

• To evaluate the effectiveness of MFPR in reducing adverse outcomes in multiple gestations.
• To assess the impact of the timing and number of fetuses on pregnancy outcomes after MFPR.

Main Methods:

• A retrospective study of 334 multiple pregnancies undergoing embryo reduction.
• Analysis of outcomes including miscarriage, preterm delivery rates (<33 and <36 weeks), total fetal loss, and gestational age at delivery.
• Subgroup analyses for reduced triplets and twin pregnancies based on procedure timing.

Main Results:

• MFPR before 15 weeks in 313 pregnancies resulted in a 9.12% miscarriage rate and a median gestational age of 35 weeks.
• In triplets reduced to twins (185 cases), miscarriage was 8.25% with a median gestational age of 36 weeks.
• First-trimester selective termination in twin pregnancies had a lower risk of severe preterm delivery compared to procedures at or after 15 weeks.

Conclusions:

• MFPR is effective in reducing pregnancy loss and severe prematurity, particularly in quadruplets and higher-order gestations.
• The risk of miscarriage is correlated with the final number of fetuses.
• First-trimester diagnosis and intervention for twin pregnancies are crucial to minimize risks of severe preterm delivery.