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Multifetal Pregnancy Reduction.

Sarah Običan1, Clifton Brock, Richard Berkowitz

  • 1Department of Obstetrics & Gynecology, College of Physician & Surgeons, Columbia University Medical Center, New York, New York.

Clinical Obstetrics and Gynecology
|June 18, 2015
PubMed
Summary
This summary is machine-generated.

Reducing higher-order multiple gestations to twins significantly improves outcomes. Multifetal pregnancy reduction lowers risks of preterm birth and enhances maternal and fetal health.

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Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • Reproductive Medicine

Background:

  • Higher-order multiple gestations (triplets or more) carry substantially increased risks for perinatal morbidity and mortality compared to twin gestations.
  • Triplet gestations typically deliver prematurely, around 33.5 weeks, with a significant percentage (<32 weeks) and a smaller but critical portion (<28 weeks), leading to severe complications.
  • Maternal complications are also markedly elevated in higher-order multiples.

Purpose of the Study:

  • To evaluate the impact of multifetal pregnancy reduction (MPR) on gestational age at delivery and maternal/fetal outcomes.
  • To assess the efficacy of reducing triplets or higher-order multiples to twins in mitigating risks associated with preterm birth.

Main Methods:

  • Multifetal pregnancy reduction (MPR) procedure involves ultrasonically guided injection of potassium chloride (KCl) into the fetal thorax to induce asystole.
  • The intervention selectively reduces the number of fetuses in higher-order gestations, aiming to improve the viability of the remaining fetus/fetuses.

Main Results:

  • MPR to twins demonstrated an average increase in gestational age at delivery by approximately 4 weeks.
  • Significant improvements in both maternal and fetal outcomes were observed following the reduction procedure.

Conclusions:

  • Multifetal pregnancy reduction is an effective intervention for managing higher-order multiple gestations.
  • Reducing triplets or more to twins substantially improves perinatal outcomes and reduces the incidence of early preterm birth.