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• W2011304643 abstract "To present a single center's experience with fetal reduction (FR) to singleton pregnancies 1) for social or psychological indications in trichorionic triplet (TCTr) and dichorionic twin pregnancies (DCTw) and 2) in dichorionic triplet (DCTr) pregnancies eliminating obstetric complications of the monochorionic component (MCTw). A retrospective analysis of our database resulted in 23 TCTr and 57 DCTw pregnancies meeting the selection criteria. In addition, 33 consecutive DCTr pregnancies opted for FR of the MCTw. FR was carried out transabdominally with a 22 G spinal needle and KCl (1 meQ/ml) under local anesthesia in the first trimester. When the MC co-fetus was in the alignment with the first, the same needle was advanced into the co-twins thorax. Five hours and 1 week after the procedure, the patient was evaluated for immediate complications. Pregnancy outcome was collected in writing from the referring physicians or by phone from the patient. Conception occurred naturally in 2/23 TCTr and 28/57 DCTw pregnancies (p < 0.001) and after ART in respectively 7/23 and 13/57 patients (NS). FR was performed at 11.1 ± 0.9 w and 11.9 ± 1.1 w for TCTr and DCTw pregnancies respectively. Eight patients with triplets (35%) and 28 with twin (49%) had a CVS of the fetus intended to remain (NS), but no chromosomal abnormalities were observed. In the reduced TCTr group, one pregnancy was terminated at 19 weeks for a congenital CMV infection, and another was lost before viability (pregnancy loss: 1/22 = 4.5%); in the reduced DCTw group no pregnancies were lost (NS). Mean GA at delivery was 37.8 ± 2.0 w and 38.8 ± 1.7 w and mean birth weight (BW) was 2821 ± 438 g and 3140 ± 562 g for reduced triplet and reduced twin pregnancies respectively. Of the 29 completed DCTr pregnancies, 4 (14%) were conceived naturally, 4 (14%) after ovulation induction and the remaining 21 (72%) after ART. FR was carried out at 11.8 ± 1.0 w. On 9 occasions, the patient had a CVS of the remaining fetus before the FR. There were no immediate complications. One pregnancy was lost (19 w) because of a PPROM; there were neither late fetal nor neonatal deaths. Mean GA at birth was 38.8 ± 2.7 w and mean BW was 3056 ± 621g. In 17 conservatively managed DCTr pregnancies (Chasen, 2002) 2 were lost completely before viability (11.8%), and another 3 had severe TTS (20%). Of the 54 fetuses, 36 (67%) were born alive at a mean GA of 33.5 w and with a median BW of 1880 g. Fourteen DCTr pregnancies with TTS, and managed by endoscopic laser surgery or coagulation of the cord (Van Schoubroeck, 2004; Sepulveda, 2005) resulted in 25 newborns without sequellae (62.5%). FR for social/psychological indications in TCTr or DCTw pregnancies carries an acceptable low pregnancy loss rate of 1/80 (1.3%). Therefore, and because termination of pregnancy for social indications in singleton pregnancies is morally justifiable, FR for social indications should not be prohibited. DCTr pregnancies managed either conservatively or surgically carry a high complication rate. FR to a singleton pregnancy however bears an insignificant obstetric risk, and should be emphasized during counseling during the first pregnancy trimester." @default.
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• W2011304643 date "2005-09-01" @default.
• W2011304643 modified "2023-10-18" @default.
• W2011304643 title "OC3.03: Dilemmas in fetal reduction" @default.
• W2011304643 doi "https://doi.org/10.1002/uog.2011" @default.
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