Selective reduction in multifetal pregnancies: technical and psychological aspects.

OBJECTIVE

To evaluate efficiency and safety of a very early transvaginal selective reduction procedure in multifetal pregnancies.

DESIGN

Prospective study.

SETTING

Obstetric and Gynecology Department, University of Paris VI.

PATIENTS

Twenty-two patients with multifetal pregnancies: 14 triplets, 8 quadruplets, and 1 quintuplet.

INTERVENTION

Selective embryonic reduction was performed at 7 weeks of amenorrhea under general anesthesia by transvaginal embryo puncture and aspiration. Two embryos were left in place.

MAIN OUTCOMES

Pregnancy outcome (immediate or delayed complication, term of delivery, newborns) and psychological impact.

RESULTS

No complication occurred. The 22 patients now have delivered at 36.5 weeks of amenorrhea, on average giving birth to 44 neonates with no congenital malformation. If the procedure generates anxiety, it is nevertheless perceived as necessary for the successful outcome of the pregnancy.

CONCLUSION

Early mechanical transvaginal embryo reduction performed at 7 weeks of amenorrhea, leaving two embryos is, in our opinion, a simple and safe procedure with no affect on remaining fetuses. It is necessary when there are four or more embryos, and it should also be proposed for triplets. In these circumstances, patients saw reduction as a necessary procedure.