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Transvaginal multifetal pregnancy reduction: Which? When? How many?
A Monteagudo1, I E Timor-Tritsch
1Sloane Hospital for Women, Columbia Presbyterian Medical Center, Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032.
Annals of Medicine
|June 1, 1993
Summary
Transvaginal multifetal pregnancy reduction is a safe procedure for mothers, with an acceptable pregnancy loss rate. This technique, particularly reducing fetuses overlying the internal os, shows comparable outcomes to transabdominal methods.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Perinatology
Background:
- Multifetal pregnancies present increased risks for perinatal outcomes.
- Fetal reduction procedures aim to improve outcomes and address patient desires.
- Transvaginal guided puncture is an established method for fetal reduction.
Purpose of the Study:
- To evaluate the safety and efficacy of transvaginal guided puncture for multifetal pregnancy reduction.
- To assess perinatal outcomes and pregnancy loss rates following the procedure.
- To compare transvaginal with transabdominal approaches for fetal reduction.
Main Methods:
- A retrospective survey of 148 multifetal pregnancy reduction procedures.
- Focus on transvaginal guided puncture technique.
- Analysis of pregnancy loss rates and gestational age at delivery.
Main Results:
- Total uncorrected pregnancy loss was 13.4%; corrected loss was 11%.
- Among remaining twins, 33/63 delivered preterm; among singletons, 2/36 delivered preterm.
- Reduction of fetuses overlying the internal os was common.
Conclusions:
- Transvaginal multifetal pregnancy reduction is safe for the mother with acceptable pregnancy loss rates.
- The procedure appears to yield outcomes comparable to transabdominal methods.
- Fetal reduction can improve perinatal outcomes in multifetal pregnancies.