Entries for Selective Reduction were Posted August 30, 1999:

1. Multiple pregnancies and fetal reduction
2. Multiple pregnancies and fetal reduction (2)
3. Multiple pregnancies and fetal reduction (3)
   

1. Multiple pregnancies and fetal reduction
Title: Reduction of multifetal pregnancies to twins does not increase obstetric or perinatal risks
Author: A. Antsaklis, et al.
Address: Athens, Greece
Source: Human Reproduction 14: 1338-1340 (May) 1999
Summary: Multiple gestations have become more commonplace, reflecting the increasing usage of assisted reproductive technologies. Most multifetal pregnancies are problematic gestations either because of the high number of fetuses or because of the presence of genetic disease in one fetus. Thus, selective reduction in cases of multiple fetuses is used more often than it was in the past. The researchers investigated whether twin pregnancies derived from fetal reduction carry a higher obstetric and perinatal risk compared to standard twin pregnancies. The study population included 158 patients who underwent embryonic reduction to twins and the control group consisted of 135 twin pregnancies conceived either naturally or after assisted reproduction. Both groups of patients had the same obstetric outcome according to perinatal mortality, gestational week at delivery, weight of neonates at birth and miscarriage rate. It must be noted that early abortions, premature births and fetal growth retardation are not prevented by fetal reduction.
Comment: Clearly multiple gestations will always be a part of therapy with our present fertility promoting technologies. Still, the best method is to avoid rather than treat multiple gestations. Presently, the two greatest advances that could be made in the field of reproductive medicine would be to reduce transfer rate after IVF to no more than two embryos and for insurance companies to recognize infertility as a disease and cover therapy. The societal and economic benefit would be enormous.
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2. Multiple pregnancies and fetal reduction (2)
Title: Multifetal pregnancy reductions of triplets to twins: Comparison with nonreduced triplets and twins
Author: Y. Yaron, et al.
Address: Detroit, Michigan
Source: American Journal of Obstetrics and Gynecology 180: 1268-1271 (May) 1999
Summary: The purpose of this study was to evaluate outcomes of triplet gestations undergoing reduction to twins with outcomes of nonreduced twin gestations and expectantly managed triplet gestations. The study included 143 triplet pregnancies that underwent reduction to twins over a 10-year period at a single center. These were compared with 12 nonreduced triplet pregnancies and 605 twin pregnancies from the Wayne State Univ. Perinatal Database, and 207 twin pregnancies from the Quest Diagnostics Database. The miscarriage rate for expectantly managed triplets was 25%, compared with 6.2% for triplets reduced to twins. Severe prematurity occurred in 25% of nonreduced triplets, compared with 4.95 of twins after reduction. Both of these rates were similar to those of nonreduced twins. Mean gestational age at delivery and mean birth weights were significantly lower for expectantly managed triplets as compared with triplets undergoing reduction to twins. Pregnancy loss rates, mean length of gestation, and mean birth weight did not vary significantly between triplets who underwent reduction to twins and nonreduced twins. It was concluded that reduction of triplets to twins significantly reduces the risk for prematurity and low birth weight and may be associated with a reduction in overall pregnancy loss.
Comment: Clearly multiple gestations will always be a part of therapy with our present fertility promoting technologies. Still, the best method is to avoid rather than treat multiple gestations. Presently, the two greatest advances that could be made in the field of reproductive medicine would be to reduce transfer rate after IVF to no more than two embryos and for insurance companies to recognize infertility as a disease and cover therapy. The societal and economic benefit would be enormous.
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3. Multiple pregnancies and fetal reduction (3)
Title: Aggressive perinatal care for high-order multiple gestations: Does good perinatal outcome justify aggressive assisted reproductive techniques?
Author:J. Angel, et al.
Address: Tampa, Florida
Source: American Journal of Obstetrics and Gynecology 181: 253-259 (August) 1999
Summary: A retrospective chart review was carried out from all high-order multiple gestations that were managed by a single perinatology group from Feb. 1993-June 1998 to determine the factors that must be considered for appropriate counseling of patients with high-order gestations. Clinical outcomes were analyzed from 9 quadruplet, 25 triplet, 19 reduced twin, and 24 nonreduced twin pregnancies. Women with quadruplet pregnancies were admitted more frequently at an early gestational age, the infants were delivered earlier, and the maternal and neonatal hospital days were longer than for triplet and reduced and nonreduced twin gestations. Triplets had an earlier gestational age at delivery, a higher incidence of preterm labor, and a higher percentage of neonatal intensive care unit admissions than reduced twin gestations. Reduced twins were hospitalized longer, were delivered earlier, had a higher incidence of preterm labor, and had a greater percentage of neonatal intensive care unit admissions, a greater percentage of birth weight and a greater frequency of respiratory distress syndrome than nonreduced twins. There was no difference in neonatal survival and neurologic morbidity when all groups were compared. Although early delivery and prolonged hospitalization were common with quadruplets and triplets, maternal and neonatal outcomes were excellent.
Comment: Clearly multiple gestations will always be a part of therapy with our present fertility promoting technologies. Still, the best method is to avoid rather than treat multiple gestations. Presently, the two greatest advances that could be made in the field of reproductive medicine would be to reduce transfer rate after IVF to no more than two embryos and for insurance companies to recognize infertility as a disease and cover therapy. The societal and economic benefit would be enormous.
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Samual Thatcher, M.D. generously has made "Thatcher's Thoughts" available for reprint on the INCIID site, and retains full copyright of his work.