ObstetricsImprovement in outcomes of multifetal pregnancy reduction with increased experience☆
Section snippets
Material and methods
A total of 3513 patients undergoing multifetal pregnancy reduction at 11 centers in 5 countries and their pregnancy outcomes formed the study material. There has been some evolution in centers and physicians with time, but the vast majority of procedures have been performed by a limited number of physicians throughout this series. Multifetal pregnancy reduction cases were considered to be reductions performed for the indication of fetal number per se. Those cases in which a fetal anomaly was
Results
The use of multifetal pregnancy reduction has steadily risen through the years, doubling in our study during the last 3 years. At some centers, however, there has been a plateauing during the past few years, which probably reflects the entry into the field of newer centers. The proportion of pregnancies initiated with assisted reproductive technologies has risen through the years to 70%, but the proportion of those cases resulting in quintuplets or higher-order multiples has fallen.
With
Comment
During the past 15 years, multifetal pregnancy reduction has become a well-established and integral adjunct to infertility therapy and subsequent attempts to deal with its sequelae. Our multicenter group has allowed us to follow the outcomes of the same physicians across time. In the mid 1980s the risks and benefits of multifetal pregnancy reduction could only be surmised.2, 3 We now have clear and precise data on the direct risks and benefits of the procedure and an understanding that the
Acknowledgements
Additional coinvestigators were as follows: Joanne Stone and Keith Eddelman, Mt Sinai Medical Center, New York; Rosalinde Snijders, King’s College, London; Lucia Tuliu, University of Milan; Jodi Lerner, Columbia University, New York; Yves Dumez, Nekker Hospital, Paris; Ana Monteagudo, New York University; and Alex Shalhoub, Mazin Ayoub, and Mark P. Johnson, Wayne State University, Detroit.
References (17)
- et al.
Selective reduction of multifetal pregnancies
Lancet
(1990) - et al.
Selective termination: clinical experience and residual risks
Am J Obstet Gynecol
(1990) - et al.
Multifetal pregnancy reduction by transvaginal puncture: evaluation of the technique used in 134 cases
Am J Obstet Gynecol
(1993) - et al.
Selective termination for structural, chromosomal, and mendelian anomalies: international experience
Am J Obstet Gynecol
(1999) - et al.
Multifetal pregnancy reductions of triplets to twins: comparison with nonreduced triplets and twins
Am J Obstet Gynecol
(1999) - et al.
Multifetal pregnancy reduction is not associated with an increased risk of intrauterine growth restriction, except for very-high-order multiples
Am J Obstet Gynecol
(1998) - et al.
Method for first trimester selective abortion in multiple pregnancy
Contrib Gynecol Obstet
(1986) - et al.
Selective first trimester termination in octuplet and quadruplet pregnancies: clinical and ethical issues
Obstet Gynecol
(1988)
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Reprint requests: Mark I. Evans, MD, Department of Obstetrics and Gynecology, MCP/Hahnemann University, 245 N 15th St-MS495, Philadelphia, PA 19102.