Selective Fetal Reduction in Triplet Pregnancy: Indian Experience — A Retrospective Review of 32 Cases

Abstract

Aim:To review the effects of selective fetal reduction in trichorionic triplet pregnancy with focus on risk of miscarriage and preterm delivery in Indian women and thus provide local data for counseling the prospective parents in similar situation. Materials and methods:This retrospective study reviewed the pregnancy outcome of 32 sets of triplet pregnancies following fetal reduction. All mothers had trichorionic triplet pregnancy with three live fetuses at 10 to 11 weeks of gestation. One to two milliliter ml of 10% potassium chloride (KCl) was injected into the heart of the target fetus to achieve asystole. Results:The miscarriage (pregnancy loss before 24 completed weeks) rate in our study was 3.12%. The delivery in our study at ≤32 and ≤35 weeks were 6.45 and 51.61% respectively. The mean gestational age (mean ± SD) of the mothers was 242.58 ± 12.93 days. Regarding the birthweight of neonates, 5.08% babies were <1500 gm, 89.83% were between 1500 and ≤2500 gm and 5.08% were > 2500 gm. The mean birth weight (mean ± SD) of the babies was 1921.18 ± 339.78 gm. There was no neonatal death in this cohort. Conclusion:Our study results, when compared with 'expectant management' group of two European studies as there was no control in our study, appeared significantly better in terms of gestational age at delivery and neonatal birth weight.Selective fetal reduction remains an effective option to Indian women with trichorionic triplet pregnancy.

A series of fetal reductions and their outcomes at a tertiary care center in North Karnataka: Fetal reduction series: A boon?

“…In our case series, the mean maternal age was 25.75 years which was much lower than the mean maternal age in the studies conducted by 33.68±3.09 years [5] and Chaudhury and Mukherjee (31.90±4.11 years) who conducted a retrospective study of 32 triplet pregnancies that had undergone fetal reduction with KCl and their maternal and perinatal outcomes [6]. The mean gestational age at which the fetal reduction was done was 13+1 weeks, after a detailed nuchal translucency scan, to rule out gross congenital anomalies.…”

“…They had not included the patients who underwent a reduction of triplets to singleton pregnancies. The mean gestational age to which the women carried to live birth was 28+2 weeks which was less compared to the mean gestational ages in the studies by Kumawat et al [5], Chaudhury and Mukherjee [6], Antsaklis et al [7], and Boulot et al [8].…”

“…The mean gestational age at which the fetal reduction was done was 13+1 weeks, after a detailed nuchal translucency scan, to rule out gross congenital anomalies. This was higher than the gestational age at which the fetal reductions were done in the study by Chaudhury and Mukherjee [6], Antsaklis et al [7], and Boulot et al [8] where the fetal reductions were done between 10 and 11 weeks. They had not included the patients who underwent a reduction of triplets to singleton pregnancies.…”

The consequences of fetal reduction for quintuplets after ICSI-ET

“…A retrospective analysis of selective fetal reduction in triplet pregnancy reported 3.12% pregnancy loss occurring before 24 weeks of pregnancy. 9 A recent study from china has reported an abortion rate of 31% when fetal reduction was undertaken at 16 to 14 weeks when compared to 8.8% abortion rate when the same procedure was undertaken between 12 to 13 +6 days and 15.6% when performed between 14-15 +6 weeks. 10 Most of the studies in literature reported on the usage of inj.…”

Multifetal Pregnancy Reduction

“…In an another study, from India, 32 sets of trichorionic triplets were reduced to twins at 10-11 weeks. Complete pregnancy loss at \24 weeks occurred in 3.12% [10]. The authors reported that 48.3% of pregnancies carried beyond 35 weeks.…”