Multifetal pregnancy twins pregnancy linkedin slideshare. Should primary prevention strategies for high order multiple pregnancies fail, multifetal pregnancy reduction may be the appropriate alternative to reduce perinatal morbidity and mortality in trichorionic. Reduction of multifetal pregnancies to twins does not. Transvaginal ultrasound guided embryo reduction technique performed between seventh and eighth weeks of gestation is an effective and safe procedure for embryo reduction with worldwide loss rate of 4. A multifetal pregnancy is an undesired outcome of assisted reproductive technology art. In vitro fertilization unit, tel aviv sourasky medical center, tel. Multifetal pregnancy reduction of triplet and higher. Multifetal reduction may decrease the risk of preeclampsia in women with higherorder multifetal gestations. Pregnancy outcome of early multifetal pregnancy reduction. Multifetal pregnancy reduction of triplet and higher order.
For the readers information, this procedure may also be referred to as selective reduction. Seventyfive patients with highorder multiple pregnancies resulting from assisted reproduction. One study reported that only 14% of 59 women with twin pregnancies remaining after multifetal reduction developed preeclampsia compared with 30% of women with triplet pregnancies 27. In selective reduction, fetuses are chosen based on health status. Also called fetal reduction or selective pregnancy reduction, its a safe. Original article effect of selective secondtrimester.
It is a difficult situation for both the physician and the patient. Multifetal pregnancy reduction is a technique that reduces the number of fetuses in an effort to increase the likelihood that the pregnancy will continue. To modify the technique of multifetal pregnancy reduction and to study the outcome of reduced twins in comparison with nonreduced twins and highorder multiple gestations. Couples who are expecting three or more babies may wish, or be advised, to consider reducing the number of viable fetuses to two. Multifetal pregnancy increases maternal, fetal and neonatal complications, most important being preterm delivery and complications of prematurity. Higherorder multiple pregnancy is associated with significant maternal and fetal complications. Mar 09, 2016 international, collaborative experience of 1789 patients having multifetal pregnancy reduction. Our study was approved by our institutions ethics committee, but it was difficult to counsel patients because of the lack of sufficient data about the procedure. The following are the most common symptoms of multiple pregnancy. We conceived many babies and chose to reduce one or two, or three.
It is performed early in pregnancy after the diagnosis of a multiple gestation. Pregnancy outcomes of different methods for multifetal. Multifetal pregnancy reduction of triplets to twins compared. Multifetal pregnancy reduction journal of obstetric. Pdf secondtrimester multifetal pregnancy reduction. Multifetal pregnancy reduction of both fetuses of a monochorionic pair by intrathoracic potassium chloride injection of one fetus. The term used by the international society of twins studies ists is multifetal pregnancy reduction and is the one used here. Multifetal pregnancy is presence of 1 fetus in the uterus. Multifetal pregnancy reduction and selective termination. A possible risk factor for periventricular leukomalacia in premature newborns. Consequently, the risks to the mother and remaining fetuses are reduced.
Includes an interactive tool to help you make your decision. Multifetal pregnancy and selective reduction by dr john i fleming the birth of septuplets to american couple bobbi and kenny mccaughey has attracted significant worldwide media attention1. Multiple gestation and multifetal pregnancy reduction. Multifetal pregnancy reduction in triplet and higherorder multiple pregnancies significantly reduces the risks of prematurity and a low birth weight, and may also be associated with a reduction in overall pregnancy. A surgery called multifetal reduction lowers the number of fetuses and improves your chances for a healthy pregnancy. Multifetal pregnancy reduction is defined as a firsttrimester or early secondtrimester procedure for reducing the total number of fetuses in a multifetal pregnancy by one or more 1. Various aspects of multifetal pregnancy reduction are discussed, including the background, options, risks, benefits, techniques, results, and appropriate physical and psychosocial support. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Multifetal pregnancy is suspected if the uterus is large for dates. If a couple or individual is thinking about or has decided to proceed with multifetal reduction, a thorough ultrasound is done to check each fetus for. Sagittal ultrasound view during multifetal pregnancy reduction shows a 22gauge needle while it is advanced to the chest of fetus d in a 10weeks quintuplet pregnancy reduced to a twin pregnancy. Reduction of triplet or higher order pregnancy is acceptable and the ending number is usually two. These pregnancies are at increased risk for a variety of problems, but preterm delivery poses the greatest threat to the fetuses.
Cervical length, multifetal pregnancy reduction, and. Several studies have shown that mpr to twin or singleton pregnancy improves obstetric outcomes compared with expectant management 3, 4, 6, 7. Should i consider a multifetal pregnancy reduction. Multifetal pregnancy reduction to twins increases gestational age at delivery by 4 weeks and significantly improves maternal. Monochorionic highorder multiple pregnancies and multifetal pregnancy reduction. Assisted reproduction often results in the implantation of multiple embryos, and the subsequent. First trimester multifetal pregnancy reduction mfpr can be performed in order to decrease the risk of complications associated with multiple gestations. The method used was transabdominal intracardiac injection. Although few practitioners have much experience with these complicated pregnancies, knowledge is growing with the increasing incidence of multifetal pregnancy. Aug 07, 2011 transvaginal ultrasound guided embryo reduction technique performed between seventh and eighth weeks of gestation is an effective and safe procedure for embryo reduction with worldwide loss rate of 4. Risk associated with multiple gestation and the option of multifetal pregnancy reduction. Multifetal pregnancy reduction mfpr as the number of higher multiple pregnancies has escalated, so have the number of couples who decide that they should maximise the chances of having healthy babies by reducing the number of fetuses a multifetal pregnancy reduction. Multifetal pregnancy reduction of triplets to twins is associated with a better pregnancy outcome compared with that of nonreduced triplets. Multifetal pregnancy reduction mfpr initially used as a procedure to selectively terminate fetuses with congenital abnormality or genetic do now, usage to terminate one or more fetuses of a multiple gestation pregnancy while allowing some fetuses to remain alive risks associated and ethical issues related to it are still a debate.
Multifetal pregnancy reduction mfpr was developed over 20 years ago to rescue higherorder multifetal pregnancies and has become a major component of improving the outcomes in infertility therapies. Request pdf multifetal pregnancy reduction multiple gestations of triplets or more have a significant increase in perinatal morbidity and mortality compared with twins. Multifetal pregnancy reduction was associated with a 7% pregnancy loss rate and no losses within the first 4 weeks after the procedure. Loss in higher multiple pregnancy and multifetal pregnancy. Cesarean delivery is recommended for twins unless the presenting twin is in vertex presentation. In most cases, the involved gestations will be higherorder multifetal pregnancies, defined by the presence of three or more fetuses. Fetal surveillance in multifetal pregnancy journal of.
Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy, say quadruplets, to a twin or singleton pregnancy. Multifetal pregnancy reduction explained multiples are on the rise, at times increasing longterm health and developmental problems for moms and their babies. Selective reduction of multifetal pregnancies for the three indications described is an ethically justifiable option for the management of multifetal pregnancy, to which there are no public policy. Discusses comparisons between twins after fetal reduction versus triplets no fetal reduction. Multiple methods of tocolysis and fetal surveillance provide unprecedented ways to improve multifetal outcomes through meticulous antepartum care. Practice bulletin, number 169, october 2016, multifetal. Multifetal pregnancy reduction 175 reproductive technologies, specifically in vitro fertilization ivf, have made it possible for infertile couples to have children. Five women were excluded from statistical evaluation because pregnancy complications precluded spontaneous delivery. Pregnancy, twins, multifetal pregnancy reduction, pregnancy outcome introduction in recent years, mfpr has become both clinically and ethically accepted as a therapeutic option in multifetal pregnancy 1, 2 and its safety and availability has increased. Nov 17, 2012 multifetal pregnancy reduction is one type of loss that is nearly impossible to share with others let alone have them fully understand the anxiety and dilemma that has been faced.
It is performed to reduce the potential for early preterm delivery associated with higherorder multiple gestations. Multifetal reduction is an elective medical procedure. Multifetal multiple pregnancy occurs in up to 1 of 30 deliveries. It was the autonomous decision of the patient who must. The mean gestational age at delivery overall was 35. If you become pregnant with three or more babies, and are at high risk for complications, you may be asked to consider multifetal pregnancy reduction. The objective of multifetal reduction is that by reducing the number of fetuses in the pregnancy, the remaining fetuses may have a better chance for health and survival.
The birth of so many babies at one time, all of them seemingly in good physical condition is, to say the least, a highly unusual event. Multifetal pregnancy merck manuals professional edition. Two of 3 67% women with a cervical length of multifetal pregnancies, multifetal pregnancy reduction mpr is offered to some patients. May 31, 2017 multifetal pregnancy reduction of triplets to twins is associated with a better pregnancy outcome compared with that of nonreduced triplets. The procedure is also called multifetal pregnancy reduction. In multifetal pregnancy reduction, the fetuses to be reduced is are chosen based on technical considerations, such as which is most accessible to intervention. Multifetal pregnancy reduction to twins increases gestational age at delivery by 4 weeks and significantly improves maternal and fetal.
Multifetal pregnancy reduction raises considerable ethical and religious debates. Multifetal pregnancy reduction is one option for women with a higherorder multiple pregnancy. Throughout the document, multifetal pregnancy reduction is used. Jun 24, 2017 multifetal pregnancy reduction mfpr initially used as a procedure to selectively terminate fetuses with congenital abnormality or genetic do now, usage to terminate one or more fetuses of a multiple gestation pregnancy while allowing some fetuses to remain alive risks associated and ethical issues related to it are still a debate. Fetal reduction is a procedure for reducing the number of fetuses to a more manageable number.
Multifetal pregnancy reduction involves the ultrasonically guided injection of kcl into the fetal thorax to induce asystole. This procedure is defined as a firsttrimester or early secondtrimester termination of one or more fetuses in a multifetal gestation, to increase the chances of survival of the remaining fetuses and decrease longterm morbidity for the delivered fetus. Multifetal pregnancy reduction 1996 acta obstetricia et. Multifetal pregnancy reduction mfpr is a procedure that reduces higherorder pregnancies, which improves perinatal outcomes. Feb 20, 2008 multifetal pregnancy reduction mfpr is a procedure that reduces higherorder pregnancies, which improves perinatal outcomes.
International, collaborative experience of 1789 patients having multifetal pregnancy reduction. Our study was approved by our institutions ethics committee, but it was difficult to counsel patients because of. As a byproduct of successful assisted reproductive technology, substantial numbers of women have conceived three or more fetuses over the past several years. Sep 29, 2005 cervical length mean sd at reduction was 4. Multifetal pregnancy reduction of triplets to twins.
The reduction to twin pregnancies occurred between the 9th and 11th weeks of amenorrhoea, although it has since been shown that selective multifetal pregnancy reduction even at a later stage around the 20th week is associated with a favourable perinatal outcome hartoov et al. Two of 3 67% women with a cervical length of reduction. Selective reduction is somewhat different than multifetal pregnancy reduction. Twin pregnancy resulting from reduction of a quintuplet pregnancy. To evaluate the pregnancy outcome of selective secondtrimester multifetal pregnancy reduction mfpr compared to firsttrimester mfpr. You may want to have a say in this decision, or you may simply want to follow your doctors recommendation. These complications include extreme prematurity before 32 weeks, low birthweight infants, fetal death in utero, high levels of perinatal mortality, and high levels of perinatal morbidity. It is associated with increased maternal morbidity eg, hypertension, diabetes, and operative delivery. Refer for fetal anomaly, discordant fetal growth, discordant amniotic fluid volume, fetal death after 16 weeks of gestation 632016 12 luke, b.