Improved results in multifetal pregnancy reduction: a report of 72 cases.

OBJECTIVE

To evaluate pregnancy outcome after either transabdominal or transvaginal multifetal pregnancy reduction.

DESIGN

A study of 72 consecutive multifetal pregnancy reductions.

SETTING

Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center Tel Hashomer, Israel.

PATIENTS

Seventy-two patients with multifetal pregnancies: 2 twins, 27 triplets, 26 quadruplets, 10 quintuplets, 3 sextuplets, 1 septuplet, 2 nontuplets, and one pregnancy with 12 fetuses.

INTERVENTION

Multifetal pregnancy reduction was performed at 9 to 13 weeks' gestation by either transabdominal or transvaginal potassium chloride injection.

MAIN OUTCOME MEASURES

Early and late complications related to the procedure, outcome of pregnancy, and comparison of two periods.

RESULTS

Procedures performed between 1984 and 1989 (36 patients) were associated with a 33.3% pregnancy loss, whereas those performed between 1990 and 1992 (36 patients) were associated with no pregnancy loss. Of the 17 patients with quintuplets or more, 10 (59%) delivered live and healthy newborns. No difference was found when comparing the transabdominal and the transvaginal approaches.

CONCLUSIONS

Both transvaginal and transabdominal approaches are comparable. There is a remarkable decrease in pregnancy loss with experience.