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First trimester selective reduction in multiple pregnancy guided by transvaginal sonography
J Itskovitz1, R Boldes, I Thaler
1Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
Journal of Clinical Ultrasound : JCU
|May 1, 1990
Summary
Transvaginal ultrasonography-guided fetal reduction is a viable technique for managing multiple pregnancies. This early selective abortion method offers advantages over other approaches, though premature delivery remains a risk.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Ultrasonography
Background:
- Multiple pregnancies present unique management challenges.
- Selective reduction is a therapeutic option for high-order multiples.
- Minimally invasive techniques are sought for improved safety and efficacy.
Purpose of the Study:
- To evaluate the efficacy and safety of transvaginal ultrasonography-guided fetal reduction.
- To compare transvaginal approach with existing transabdominal or transcervical methods.
- To establish transvaginal fetal reduction as a preferred early selective abortion technique.
Main Methods:
- Transvaginal ultrasonography guidance was employed for fetal reduction in 11 patients.
- Embryonic aspiration was performed between 7-8 weeks gestation.
- Fetal intrathoracic injection was performed between 9-11 weeks gestation.
Main Results:
- Seven patients delivered healthy babies at >35 weeks gestation.
- Three patients delivered prematurely (15-17 weeks post-procedure).
- Neonatal death occurred in all premature twin deliveries.
Conclusions:
- Transvaginal ultrasonography-guided fetal reduction effectively manages multiple pregnancies.
- This method overcomes technical challenges associated with transabdominal/transcervical approaches.
- Early selective abortion via transvaginal route is a promising technique despite risks of premature delivery.