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Multifetal pregnancy reduction: is it always justified?

A Benshushan¹, A Lewin, J G Schenker

¹Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel.

Fetal Diagnosis and Therapy

|May 1, 1993

Summary

Multifetal pregnancy reduction significantly improves survival rates for high-order multiples. However, reducing triplets may not be justified due to high spontaneous triplet survival rates and risks.

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Area of Science:

Reproductive Medicine
Maternal-Fetal Medicine
Obstetrics

Background:

High-order multifetal pregnancies pose significant risks to both mother and fetuses.
Previous data on multifetal pregnancy reduction (MFPR) survival rates are often confusing due to small sample sizes.

Purpose of the Study:

To provide a comprehensive overview of survival rates following MFPR for high-order multifetal pregnancies.
To analyze MFPR outcomes based on the number of fetuses and reduction targets.

Main Methods:

Systematic review of global literature on MFPR from 1985-1992.
Inclusion of the authors' own clinical experience.
Data classification based on the initial number of fetuses and the number of fetuses post-reduction.

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Main Results:

Survival rates for pregnancies reduced to twins: 91.6% (triplets), 92.6% (quadruplets), 72.5% (quintuplets), and 87.1% (septuplets or more).
Pregnancies reduced to triplets had similar outcomes whether reduced from quadruplets (85.7%) or quintuplets (72.5%).
The survival rate for triplets reduced to twins was 91.6%.

Conclusions:

MFPR is associated with high survival rates for reduced high-order multifetal pregnancies.
The justification for fetal reduction in triplet pregnancies is questioned due to high spontaneous triplet survival rates and patient history of infertility.
A conservative approach to triplet reductions is suggested, particularly when requested by patients or performed early in pregnancy.