Multifetal reduction increases the risk of preterm delivery and fetal growth restriction in twins: A case-control study

Silver, Richard K.; Helfand, Brian T.; Russell, Tanya L.; Ragin, Ann B.; Sholl, John S.; MacGregor, Scott N.

doi:10.1016/s0015-0282(97)81851-1

Cited by 49 publications

(16 citation statements)

References 6 publications

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“…Fetal growth restriction is more frequently observed in twins after reduction than among natural twins (6,16). It could be explained by the persistence of fetal tissue in the uterine cavity, which could limit the intrauterine surface available for placenta development and decrease the nutritional exchange (16). This residual tissue also could induce a subclinical inflammatory response that could play a role in spontaneous preterm labor (16).…”

Section: Discussionmentioning

confidence: 99%

“…It could be explained by the persistence of fetal tissue in the uterine cavity, which could limit the intrauterine surface available for placenta development and decrease the nutritional exchange (16). This residual tissue also could induce a subclinical inflammatory response that could play a role in spontaneous preterm labor (16). Although fetal reduction is an effective measure to decrease morbidity and mortality of high-order multiple pregnancies, it does not eliminate all the risks, such as prematurity and low birth weight (6).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Quintuplets after a transfer of two embryos following in vitro fertilization: a proved superfecundation

Peigné¹,

Andrieux

Philippe

et al. 2011

Fertility and Sterility

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quintuplets after a transfer of two embryos following in vitro fertilization: a proved superfecundation

Peigné¹,

Andrieux

Philippe

et al. 2011

Fertility and Sterility

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“…Under transabdominal ultrasonography control, a suction catheter is led through the cervix channel, and the gestational sack in the lowest location is aspired. This method is, however, being abandoned due to frequent occurrence of uncontrollable bleeding resulting in termination of pregnancy, and high risk of infection (Berkowitz et al, 1988;Dechaud et al, 1998 A number of studies may be found in the literature which document negative effects of reduction on perinatal results of twin pregnancies (Alexander et al, 1995;Melgar et al, 1991;Silver et al, 1997). For example, Melgar et al (1991) demonstrated this on a group of 14 twin pregnancies originated as a result of reduction of triple and quadruple pregnancies, by comparing them with 22 twin pregnancies where reduction was not performed.…”

Section: Discussionmentioning

confidence: 99%

Multi-Fetal Pregnancy Reduction Does Not Influence Perinatal Results in Twin Pregnancies

Jirsová¹,

Mardešić²,

Muller³

et al. 2001

Twin res.

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The objective of this study was to compare perinatal results in multifetal pregnancies where the reduction to twins was performed with non-reduced twin pregnancies. Perinatal results in 99 sets of twins after transabdominal multifetal pregnancy reduction of triple and higher-order multiple pregnancies performed in a single center were compared with a control group consisting of 151 twin pregnancies conceived in the same time period after infertility treatment, which were not a result of reduction. The main outcome measures were length of pregnancies, weight of the newborns, percentage of miscarriages and the mode of the delivery were analyzed. No significant difference could be found at a 5% level of significance regarding the average duration of pregnancy or average weight of the twins. Fisher test on 5% significance level did not ascertain any significant difference in the probability of miscarriage between the group with reduction (5.26%) and the group without reduction (12.84%). At a 5% level of statistical significance, no significant difference in probability of perinatal death of the fetus or delivery of a stillborn fetus was found. The percentage of cesarean sections did not differ significantly in both groups. The analysis of both groups demonstrated that reduction of multifetal pregnancies to twins may not influence perinatal results in comparison to twin pregnancies where reduction was not performed.

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“…This information may be useful for prognostic counseling in cases of spontaneous IUFD in twins, and may be a better comparison group for cases of late 1st trimester and early 2nd trimester selective termination [11], multifetal pregnancy reduction in the late 1st trimester and early 2nd trimester [12][13][14], or delayed interval delivery. In addition, identification of cotwin survivors may allow longitudinal study of the long-term development outcomes in cotwin survivors compared to matched controls [15].…”

Section: Introductionmentioning

confidence: 99%

Natural History of Twin Gestation Complicated by in utero Fetal Demise: Associations of Chorionicity, Prematurity, and Maternal Morbidity

et al. 2003

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Objectives: To evaluate the pathophysiology by which the in utero death of 1 twin might increase morbidity to its co-twin survivor and its mother. To assess previously reported risks for maternal disseminated intravascular coagulopathy, peripartal hemorrhage, retained placenta and infection, as well as the fetal risk of prematurity. Material and Methods: A retrospective analysis of the natural history of twin pregnancies from three institutions was performed. A total of 1,989 cases of twin pregnancy were identified, Wayne State University included 1,266 cases from 1984 to 1993; Madigan Army Medical Center 136 cases, 1995–2000, and Rockford Regional Perinatal Center, 587 cases, 1990–2000. The findings were classified by the presence or absence of fetal death in utero (IUFD) as follows: both IUFD (0/0); 1 IUFD (0/+), and both live born (+/+). A case-control study was performed on the subgroup of patients for whom complete records as to chorionicity, etc., were available. Results: Of the 1,989 cases reviewed there were 49 both IUFD (0/0), 61 complicated by 1 IUFD (0/+), and 1,879 with both live born (+/+). The overall fetal death rate for this twin cohort was 55/1,000. IUFD of 1 or both twins was related to an increased risk of previable delivery 55% in 0/0, and 28% in 0/+ versus 4% for +/+ with p < 0.001. IUFD also was associated with early preterm delivery (mean gestational age at delivery of 23 (0/0) and 30 (0/+) versus 35 (+/+) weeks). Chorionicity as well as maternal risks were examined in the case-control study (24 (0/0), 43 (0/+), 134 (+/+)) with the following results: monochorionic placentation was more likely in pregnancies complicated by IUFD (54% (0/0), 51% (0/+) versus 14% (+/+); p < 0.001). Retained placenta, requiring dilation and curettage, occurred more frequently when both twins died in utero, but may be related to the earlier gestational age at delivery. Discussion: Independent of retained placenta, there is no difference in the maternal risks for hemorrhage, abruption, coagulopathy or infection between groups. Immaturity at delivery and monochorionicity are more common in pregnancies complicated by fetal demise. Neonatal morbidity and developmental outcome will be the focus of a longitudinal study comparing cotwin survivors to twins matched for chorionicity and gestational age at delivery.

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Multifetal reduction increases the risk of preterm delivery and fetal growth restriction in twins: A case-control study

Cited by 49 publications

References 6 publications

Quintuplets after a transfer of two embryos following in vitro fertilization: a proved superfecundation

Quintuplets after a transfer of two embryos following in vitro fertilization: a proved superfecundation

Multi-Fetal Pregnancy Reduction Does Not Influence Perinatal Results in Twin Pregnancies

Natural History of Twin Gestation Complicated by in utero Fetal Demise: Associations of Chorionicity, Prematurity, and Maternal Morbidity

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