Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations

Smith‐Levitin, Michelle; Kowalik, Ania; Birnholz, Jason C.; Skupski, Daniel; Hutson, J. M.; Chervenak, Frank A.; Rosenwaks, Zev

doi:10.1016/s0002-9378(96)80017-2

Cited by 72 publications

(28 citation statements)

References 12 publications

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“…Slowed midgestation fetal growth, in turn, has been significantly associated with preterm birth in singletons (35)(36)(37), twins (24), and triplets (38). Fetal reduction of triplets to twins has been associated with lower birthweight, shorter gestation, and greater birthweight discordancy (39)(40)(41)(42)(43)(44).…”

Section: Discussionmentioning

confidence: 99%

The effect of early fetal losses on twin assisted-conception pregnancy outcomes

Luke

Brown

Grainger

et al. 2009

Fertility and Sterility

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Section: Discussionmentioning

confidence: 99%

The effect of early fetal losses on twin assisted-conception pregnancy outcomes

Luke

Brown

Grainger

et al. 2009

Fertility and Sterility

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“…The procedure was judged to be safe. Other studies to be consulted are those by Lipitz et al ( 1994Lipitz et al ( , 1997 , Berkowitz et al ( 1996 ) , Lynch et al ( 1996 ) , Haning et al ( 1996 ) , and Smith-Levitin et al ( 1996 ) . Sebire et al ( 1997b ) reported less fortunate results when reducing triplets to twin pregnancies, while Albrecht and Tomich ( 1996 ) and Lipitz et al ( 1996 ) suggested to have had better successes.…”

Section: Triplets and Higher Multiple Birthsmentioning

confidence: 99%

Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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“…This difference can be expressed in another way: the proportion of births 24-32 weeks in twins after MFPR is 8.2 % compared to 24% in triplets not reduced [20]. In the study by Smith-Levin et al [22] of births resulting from assisted reproduction techniques, reduced twins were born at an average 35.3 weeks versus 33.5 for triplets.…”

Section: Observed Results Of Mfpr On Gestational Durationmentioning

confidence: 99%

“…In some studies the duration of gestation of twin pregnancies after MFPR is less than for pregnancies of spontaneous twins [1,12,20]. Others have found no difference between spontaneous or reduced twins [22]. Singleton births after multifetal pregnancy reduction may also have a higher rate of preterm birth compared to singleton pregnancies [9,12].…”

Section: Observed Results Of Mfpr On Gestational Durationmentioning

confidence: 99%

“…Countries in which there is a strong regulation of the risk of higher order multiples, by restrictions on the number of embryos that can be transferred, have a lower proportion of triple or quadruple pregnancies compared with countries in which no regulation exists. In the data series of Smith-Levitin [22],Haning [12],Sebire [20],Radestad [17] or De Mouzon [6], all but the Swedish series show high rates of multifetal pregnancy reduction in triplet or higher order multiples pregnancies. The lower Swedish rate could be explained by the small proportion of higher order multiples linked to the strong limitations on the number of embryos which can be transferred.…”

Section: Practice Of Mfprmentioning

confidence: 99%

See 1 more Smart Citation

Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies?

Papiernik¹,

Grangé²,

Zeitlin³

1998

Jpme

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This article reviews the arguments for the use of multifetal pregnancy reduction (MFPR) for the prevention of preterm deliveries in triplet and higher order multiple pregnancies and evaluates its effectiveness based on data from published studies. The arguments in favour of pregnancy reduction are based on the substantial mortality and morbidity associated with these pregnancies. Triplets and higher order multiples have increased rates of preterm delivery and intrauterine growth retardation, both of which are independent risk factors for death and handicap. Even controlling for gestational age, rates of mortality and handicap are higher for multiples than for singletons. Moreover, the family's risk of losing a child or having a handicapped child is greater because there are more infants at risk. MFPR effectively lowers these risk by reducing the frequency of preterm delivery. However, its effectiveness may be limited. In some studies, the proportion of preterm deliveries in reduced pregnancies remains above levels found in spontaneous twin or singleton pregnancies and MFPR does not appear to reduce the prevalence of low birth weight. Furthermore, the procedure itself has unwanted side effects: it increases the risk of miscarriage, premature rupture of the membranes and causes adverse psychological effects such as grief or depression for many patients. The authors note that a majority of the higher order multiple pregnancies result from a medical intervention in the first place, either through IVF techniques or the use of ovulation stimulation drugs. Although MFPR is an effective measure for reducing the substantial morbidity and mortality associated with higher order multiple pregnancies, preventive methods, such as limiting to 2 the number of embryos transferred for IVF and better control of the use of ovulation induction drugs, remain more effective and less intrusive.

show abstract

Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations

Cited by 72 publications

References 12 publications

The effect of early fetal losses on twin assisted-conception pregnancy outcomes

The effect of early fetal losses on twin assisted-conception pregnancy outcomes

Multiple Pregnancies

Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies?

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