Intracranial Injection with KCI: An Alternative Method in Selected Cases of Multifetal Pregnancy Reduction

Lembet, Arda; Selam, Belgin; Bodur, Harika; Ergin, Tolga; Demirel, Cem

doi:10.1159/000243714

Cited by 5 publications

(8 citation statements)

References 14 publications

(5 reference statements)

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“…There are a variety of methods by which to induce late TOP, which can include fetal intracardiac injection of other substances (such as a fibrin adhesive [13] or lidocaine [14]), other routes of injection (for example intracranial injection [15] or intraplacental injection of methotrexate [16]), intraumbilical air embolism [17], intra-amniotic digoxin [18], as well as surgical methods (such as radiofrequency ablation and cord occlusion). Whilst we do not expect significant differences in imaging features with different substances injected via an intracardiac route, this was not formally assessed in our study.…”

Section: Discussionmentioning

confidence: 99%

Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths

et al. 2018

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Objective: The aim of this study was to characterise the imaging features seen in fetuses having undergone feticide by intracardiac potassium chloride injection compared to those of non-terminated fetuses at post-mortem magnetic resonance imaging (PMMRI). Methods: A case-control study was performed comparing PMMRI findings between two groups of patients – those having undergone feticide were matched to a control group of miscarried/stillborn fetuses. The groups were matched according to gestational age, weight, and time since death. Two independent readers reviewed the PMMRI for thoracic, abdominal, and musculoskeletal imaging features. The Fishers exact test was conducted for differences between the patient groups. Results: Twenty-six cases of feticide (mean gestation 25 weeks [20–36]) and 75 non-terminated fetuses (mean gestation 26.7 weeks [19–36]) were compared. There was a higher proportion of feticide cases demonstrating pneumothorax (23.1 vs. 1.3%, p = 0.001), haemothorax (42.3 vs. 4%, p = 0.001), pneumopericardium (30.8 vs. 5.3%, p = 0.002), and haemopericardium (34.6 vs. 0%, p = 0.0001). Intracardiac gas and intra-abdominal findings were higher in the feticide group, but the differences were not statistically significant. Conclusion: Characteristic PMMRI features of feticide can help improve reporter confidence in differentiating iatrogenic from physiological/pathological processes.

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Section: Discussionmentioning

confidence: 99%

Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths

et al. 2018

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“…[1] Presently, the preferred method for MFPR is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). [6,7] Evidence suggests these methods are effective at 14 to 23 weeks of gestation for multifetal pregnancies derived from multiple eggs. [8] However, pregnancy loss rates of 7% to 9% for triplets and quadruplets and 42.9% for 6 or more fetuses following intrathoracic injection of KCl have been reported.…”

Section: Discussionmentioning

confidence: 99%

A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery

Wu²,

Zhang³

2017

Medicine

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Rationale:The preferred method for multifetal pregnancy reduction (MFPR) is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). However, in monochorionic multiple pregnancies (MMPs), especially in monoamnionic multifetal pregnancies, selective feticide by this method is often associated with miscarriage of the remaining fetuses. Selective fetal reduction in MMPs by blood flow ablation using radiofrequency ablation or fetoscopic laser surgery may improve survival of the remaining fetus. Although often successful, MFPR by these methods is contraindicated in cases of twin reversed arterial perfusion (TRAP) sequence in triplet pregnancies complicated by polyhydramnios or anterior placenta, as it is difficult to locate the ablation target.Patient concerns:2 cases were admitted to Xiangya Hospital, Central South University with triplet pregnancies at 23 or 21weeks of gestation.Diagnoses:Case 1 was a 29-year-old woman with a triplet pregnancy in 2 distinct amniotic sacs and 1 fetus with multiple malformations. Case 2 was a 32-year-old woman who was identified as a triplet pregnancy with TRAP sequence with an acardiac/acephalic twin and anterior placenta.Interventions:Both of the 2 cases were underwent a new method for MFPR involving fine needle amniotic fluid aspiration and injection of hypertonic sodium chloride (10% NaCl) into the Wharton jelly of the umbilical cord.Outcomes:The 2 cases resulted in selective feticide and the birth of the remaining infants from the triplet pregnancies. All infants were healthy at birth and the 2-year follow-up.Lessons:The new approach provided a safer, more accessible, and more cost-effective method for MFPR in MMPs with a contraindication to fetoscopic surgery compared to radiofrequency ablation and fetoscopic laser surgery.

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“…The cerebral blood supply was sufficient for KCl to enter the circulation quickly, leading to faster hyperkalemia and to fetal cardiac arrest. This mechanism, suggested by Lembet et al [9], is due to KCl directly getting into the arteries above the cranial tissues and entering the circulation. It is believed that intracranial puncture is more likely than other approaches to quickly enter the fetal circulation since these authors observed no fetal heart arrhythmia when the needle was introduced [9].…”

Section: Discussionmentioning

confidence: 99%

“…This mechanism, suggested by Lembet et al [9], is due to KCl directly getting into the arteries above the cranial tissues and entering the circulation. It is believed that intracranial puncture is more likely than other approaches to quickly enter the fetal circulation since these authors observed no fetal heart arrhythmia when the needle was introduced [9]. Observations for fetal cardiac arrest should continue for 20 min after injection to make sure the reduction is completed [10].…”

Section: Discussionmentioning

confidence: 99%

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Intracranial KCl Injection - An Alternative Method for Multifetal Pregnancy Reduction in the Early Second Trimester

Yang

Chen

et al. 2013

Fetal Diagn Ther

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Objective: This study aimed to assess the effectiveness and feasibility of transabdominal intracranial KCl injection as an alternative to intrathoracic KCl injection for multifetal pregnancy reduction (MFPR) in the early second trimester. Methods: In this study, 40 cases who underwent fetal reduction between 12 and 18 weeks of gestation at the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2011 were divided into two groups: group A (16 cases of intracranial injection) and group B (24 cases of intrathoracic injection). The groups were compared for clinical procedures and outcomes. Results: The two groups were similar in terms of patient age, gestation, as well as starting and finishing fetal numbers. Group A needed significantly fewer punctures for each fetus than group B did (1.1 ± 0.2 vs. 1.4 ± 0.6), but both groups received similar doses of KCl (2.6 ± 0.8 ml vs. 2.6 ± 1.2 ml per fetus). All cases succeeded in the first procedure, with no heartbeat recovery. The two groups had similar miscarriage rates and gestational ages at delivery. Conclusion: MFPR by intracranial KCl injection was as effective as, but an easier procedure than intrathoracic KCl injection between 12 and 18 weeks of gestation.

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Intracranial Injection with KCI: An Alternative Method in Selected Cases of Multifetal Pregnancy Reduction

Cited by 5 publications

References 14 publications

Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths

Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths

A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery

Intracranial KCl Injection - An Alternative Method for Multifetal Pregnancy Reduction in the Early Second Trimester

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