First-Trimester Multifetal Pregnancy Reduction: Evaluation of Technical Aspects and Risks from 2,756 Cases in the Literature

Abstract

Objective: To evaluate the technical aspects, efficacy and safety of first-trimester multifetal pregnancy reduction in the management of multifetal pregnancies, an analysis of the international literature on first-trimester multifetal pregnancy reduction was made. Materials: Thirty-three studies were selected from an international review of the literature. Total fetal loss rate, risk of fetal loss after the procedure with the different techniques and gestational age at delivery were the main parameters studied. The Kruskal-Wallis test and Mann-Whitney test were used for statistical analysis. Results: 2,756 multifetal pregnancy reductions were performed (2,145 transabdominal, 363 transcervical, and 248 transvaginal procedures). Total fetal loss rates were different: 16.7% for the transabdominal, 24.8% for the transcervical and 10.9% for the transvaginal procedure (p = 0.03). The risk of fetal loss was 12% for the transabdominal, 20% for the transcervical, and 10% for the transvaginal approach at less 24 weeks of gestation (p = 0.04). There was no difference for the gestational age at the time of the procedure, the initial and final number of embryos, and the gestational age at delivery. Conclusion: Because the transvaginal approach seems to be the safer procedure, surgeons may opt for it. The transcervical approach has a high fetal loss rate and should be excluded.

Pregnancy Outcomes of Different Methods for Multifetal Pregnancy Reduction: A Comparative Study

“…However, studies that have focused on loss rates per gestational sac or embryo, not per patient, observed that the rates of spontaneous fetal demise in multiple gestations during early pregnancy were much lower than those reported by other studies that did not consider this condition (29-31). Moreover, reported rates of malformation after MFPR are lower than expected rates, which is probably due to the tendency to selectively reduce embryos with a higher risk of congenital malformation (12). Several studies reported that MFPR during early gestation, at 7-8 weeks, without KCl injection showed superior results to that performed later (13, 16).…”

“…Several studies have been conducted on different routes of approach, and shown controversial results (12, 15, 32). Experience and skill are also important factors in addition to the route of approach.…”

“…Various options are available in regard to the route of approach, the timing of procedure, and the use of embryotoxic agents such as potassium chloride (KCl). However, controversy still exists regarding which method is better than the others (12-15). We retrospectively analyzed different methods for MFPR to evaluate the outcomes of procedure, and to determine which produces the better outcomes.…”

Is it worth reducing twins to singletons after IVF‐ET? A retrospective cohort study using propensity score matching

“…Despite some ethical concerns, multifetal reduction in high‐order multiple pregnancies is widely accepted as a procedure that does more good than harm. Many previous studies have shown that multifetal reduction in high‐order multiple pregnancies can improve pregnancy outcomes . For twin pregnancy, which accounts for the vast majority of multiple pregnancies after ART, pregnancy outcomes are far from as good as those of singletons.…”

“…Many studies have shown that multifetal reduction of high‐order multiple pregnancies results in improved pregnancy outcomes . However, whether conducting elective fetal reduction from dichorionic twins after IVF is worthwhile remains controversial.…”