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Procedural and obstetric outcomes after embryo reduction v s fetal reduction in multifetal pregnancy
Author(s) -
Kim M. S.,
Choi D. H.,
Kwon H.,
Ahn E.,
Cho H. Y.,
Baek M. J.,
Shin J. E.,
Moon M. J.
Publication year - 2019
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.19024
Subject(s) - medicine , miscarriage , obstetrics , incidence (geometry) , gestational age , pregnancy , fetus , odds ratio , gynecology , genetics , physics , optics , biology
ABSTRACT Objective To compare the obstetric outcome and incidence of procedure‐related adverse events after embryo reduction (ER) vs fetal reduction (FR), in multifetal pregnancies undergoing reduction to twins or singletons. Methods We analyzed retrospectively data from multifetal pregnancies that underwent transvaginal ER ( n = 181) at a mean gestational age of 7.6 weeks or transabdominal FR ( n = 115) at a mean gestational age of 12.9 weeks between December 2006 and January 2017. FR was performed after a detailed fetal anomaly scan. The two groups were compared with respect to obstetric outcomes, such as incidence of miscarriage, early or late preterm delivery, maternal complications and fetal loss, and procedure‐related adverse events, including incidence of subchorionic hematoma and procedure‐related fetal loss. Results Compared with pregnancies that underwent ER, the incidence of procedure‐related fetal loss was lower in the FR group (7.2% vs 0.9%; P = 0.039; odds ratio (OR), 0.12; 95% CI, 0.02–0.89). Mean gestational age at delivery for twins was 34.2 weeks in the ER group and 35.7 weeks in the FR group ( P = 0.014). Compared with the ER group, the FR group had lower miscarriage (8.8% vs 2.6%; P = 0.045; OR, 0.28; 95% CI, 0.08–0.97) and overall fetal loss (13.3% vs 5.2%; P = 0.031; OR, 0.36; 95% CI, 0.14–0.91) rates. Conclusions The FR procedure is, overall, a better and safer approach to reducing morbidity and mortality in multifetal pregnancies. Spontaneous demise of one fetus may occur after ER, and FR has the advantage that chorionic villus sampling and ultrasound screening for increased nuchal translucency and anatomical defects can be conducted before the procedure. The ER approach is still reasonable when a patient's religious or other ethical concerns are of primary importance. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.