From January 2001 to September 2001, MFPR were performed for 26 multifetal pregnancies after infertility treatment. Transvaginal selective embryo aspiration was performed at the ninth week of gestation, without KCl injected in the vicinity of the fetal heart. The mean number of viable embryos before and after reduction was 3.4 and 2.1. There were no complications recorded after the procedure such as vaginal bleeding, amniotic leakage and infection. The rate of miscarriage before 24 weeks was 7.1%. The mean gestation length and the mean birth weight were 36.22.8 weeks and 2360.0349.4g for the twins, respectively, and 30.67.6 weeks and 2066.7177.9 g for the triplets. Results from this study were comparable to the other studies worldwide. Preliminary data from this study showed that early transvaginal embryo aspiration without using KCl is a safe, effective method to improve obstetric outcome of multifetal pregnancies after infertility treatment.
Pregnancy Reduction, Multifetal ; Infertility ; therapy

As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of multifetal pregnancies has increased exponentially. In parallel with this increase methods of care for women carrying multiple fetuses have become more complex and well developed. Importantly, it has become obvious that in the case of such pregnancies the rates of mortality and morbidity of both fetuses and mothers, particularly in cases where four or more fetuses are involved, are extremely high. Improvements in the techniques of assisted fertilization should result in fewer yatrogenic multifetal pregnancies and a commensurate decrease in related risks. Fetal reduction seems to be an acceptable method of improving maternal and fetal outcome in high order multiple pregnancies despite the many unresolved medical and ethical dilemmas.
*Ethics, Medical ; Female ; Human ; Pregnancy ; *Pregnancy Reduction, Multifetal/adverse effects/methods ; *Pregnancy, Multiple

The purpose of this study was to evaluate the outcomes of various methods of multifetal pregnancy reduction (MFPR) and to determine which method produces better outcomes. One hundred and forty-eight patients with multiple pregnancies resulting from assisted reproduction programs and underwent MFPR were included. According to the use of potassium chloride (KCl), patients were divided into 'KCl', and 'non- KCl' groups, and based on gestational age at the time of procedures, patients were divided into 'Early' (before 8 weeks of gestation) and 'Late' (at 8 weeks or later) groups. Firstly, to clarify the effect of each component of MFPR procedure, data were analyzed between 'KCl' and 'non-KCl' groups, and between 'Early' and 'Late' groups with adjustments. Secondly, comparison between 'Early, non-KCl' and 'Late, KCl' groups was performed to evaluate the combinative effect of both components. Non-KCl groups showed a significantly higher take-home-baby rate, and lower risk of extreme prematurity and preterm premature rupture of membranes (PPROM) than KCl groups. Early groups showed a lower immediate loss rate than Late groups. As compared with 'Late, KCl' group, 'Early, non-KCl' group was superior in terms of immediate loss, pregnancy loss, take-home-baby, and PPROM rates. Our data suggest that the 'Early, non-KCl' method may be a better option for MFPR.
Adult ; Female ; Humans ; Potassium Chloride/therapeutic use ; Pregnancy ; *Pregnancy Outcome ; Pregnancy Reduction, Multifetal/*methods ; Retrospective Studies

OBJECTIVE: This study is directed to evaluate the pregnancy loss rate resulting from genetic amniocentesis after multifetal pregnancy reduction. METHODS: From March 1998 to April 1999, total 145 patients with multifetal pregnancy were included in this study. Pregnancy loss in a study population of 44 patients who underwent genetic amniocentesis after multifetal pregnancy reduction were compared with a control group of 99 patients who did not have genetic amniocentesis after multifetal pregnancy reduction. RESULTS: The pregnancy loss rate in patients who underwent genetic amniocentesis after multifetal pregnancy reduction was 2.2% (1/44) compared with 4% (4/99) in the controls (P>.05). In the study group, one woman lost her pregnancy at 19 weeks' gestation, 3 weeks after the genetic amniocentesis, and the predisposing factor was spontaneous rupture of membranes. CONCLUSION: Genetic amniocentesis following multifetal pregnancy reduction does not increase the risk of pregnancy loss.
Amniocentesis* ; Causality ; Female ; Humans ; Membranes ; Pregnancy ; Pregnancy Reduction, Multifetal* ; Rupture, Spontaneous

OBJECTIVE: To compare the pregnancy outcomes of transvaginal multifetal pregnancy reduction (MFPR) according to the gestational period when the procedure was performed METHODS: From January l995 to February 1998, total 27 patients with multiple pregnancy were included in this study. The patients were grouped to early MFPR group (<8 weeks, n=16) and delayed MFPR group (>8 weeks, n=ll) according to the gestational age that MFPRs were performed. All MFPRs were performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The complete pregnancy loss rate before 24 weeks of gestation, spontaneous loss of embryo, procedure-related complication, gestational age at delivery, and pregnancy complication were compared between the two groups. Statistical analysis of data was performed using Students t-test and Fishers exact test as appropriate. Statistical significance was defined as p<0.05. RESULTS: There was no significant difference in the complete pregnancy loss rate between the early MFPR group (6.3%) and the delayed MFPR group (27.3%). The incidence of partial spontaneous loss of embryo in the two groups were not differed significantly (6.3% vs. 18.2%). The procedure-related complication of the delayed MFPR group (36.4%) seemed to be higher than that of the early MFPR group (6.3%), however there was no statistical difference (p=0, 07). Especially, all 3 patients in whom the MFPR was performed after 10 weeks suffered from the procedure-related complication. The mean gestational age at delivery of the two groups were not differed significantly (36.3+2.8 weeks vs. 37.0+1.3 weeks). There was also no significant difference in the mean birth weights of the two groups (2378.8+563.7 gm vs. 2427.1+436.2 gm). CONCLUSION: Although there was no statistically significant difference, the early transvaginal MFPR might be a safe and useful method without significant adverse complications compared to the delayed MFPR.
Birth Weight ; Embryonic Structures ; Female ; Gestational Age ; Humans ; Incidence ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple

In infertile patients, the pregnancy loss rate after demonstration of fetal heart beat ranges about 7 % to 11 %, which is relatively higher than that of normal population(about 1.5~3.3 %). But scanty data are available in evaluation of the influence of maternal age on pregnancy outcomes in IVF-ET patients. Thus, this study was done to assess the imp-act of maternal age on pregnancy loss rate after the early sonographic detection of fetal cardiac activity following IVF-ET. Pregnancy outcomes of 338 IVF-ET cycles from January 1, 1994 through December 31, 1995 were analyzed. Trans vaginal ultrasonography was done serially from the day 21 postconception and the presence of fetal heart activity was documented using a Samsung 125-MAX scanner with a 6.5-MHz transvaginal probe. Logistic regression analysis was done to determine the possible effects of various independent factors such as treatment pr- otocol, infertility factors, basal LH, FSH and E2, multifetal pregnancy reduction, and age of the wife, on probability of spontaneous pregnancy loss after confirmation of positive fetal heart beat. The overall pregnancy loss rate was 8.0 %(27/338). The probability of pregnancy loss after positive fetal heart beat increased with age of the wife(logistic regression analysis, P<0.05). The probability of spontaneous pregnancy loss at a given age was expressed as the following formula:probability=ex/(1+ex), in which x=-3.9+0.2xage. The older women age over 35 had approximately twice the pregnancy loss rate compared to the younger women ; 14.9 %(7/47) vs. 6.9 %(20/291). The pregnancy loss rate after multifetal pregnancy reduction was 9.8 %(6/61), which was not significantly different from tht 7.6 %(21/277) without multifetal pregnancy reduction(p>0.05). We conclude that spontaneous pregnancy loss rate after documentation of fetal cardiac activity increases as a function of the maternal age and a profound effect was observed after age 35. Thus, older patients should be counselled on the higher risk of spontaneous pregnancy loss.
Female ; Fetal Heart ; Fetus* ; Humans ; Infertility ; Logistic Models ; Maternal Age ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Reduction, Multifetal ; Pregnancy* ; Spouses ; Ultrasonography

OBJECTIVE: To evaluate the feasibility and effectiveness of fetal reduction by transabdominal intracranial KCl injection for multifetal pregnancies in the early second trimester. METHODS: The data of 363 patients who underwent transabdominal fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2019 were analyzed retrospectively. According to the location of fetal reduction, they were divided into two groups: Intracranial injection group (n=196) and intrathoracic injection group (n=167). The process of fetal reduction and pregnancy outcome of the two groups were compared. RESULTS: There was no significant difference between the two groups in the average age and the proportion of type of infertility before assisted reproductive technology, conception method, indication for fetal reduction, starting number of fetuses, reduced number of fetuses, and finishing number of fetuses (P>0.05). There was no significant difference between the two groups in the proportion of the number of puncture ≥ 2 times (12.1% vs. 8.6%, P=0.249) and the incidence of replacing puncture site (10.7% vs. 6.4%, P=0.161). The next day after fetal reduction, color Doppler ultrasound was rechecked. In the intracranial injection group and intrathoracic injection group, the incidence of fetal heartbeat recovery [3.6% (8/224) vs. 1.1% (2/187), P=0.188], the volumes of KCl used [(2.6±1.0) mL vs. (2.8±1.1) mL, P=0.079], and the abortion rate within 4 weeks after fetal reduction (1.0% vs. 0.6%, P=0.654) were of no significant difference. In addition, there was no significant difference in the total abortion rate after fetal reduction, premature delivery rate, cesarean section rate, delivery gestational week and neonatal birth weight between the two groups (P>0.05). CONCLUSION Intracranial KCl injection can be an effective alternative to intrathoracic KCl injection for multifetal pregancy reduction.
Cesarean Section ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal/methods* ; Pregnancy Trimester, Second ; Retrospective Studies

BACKGROUNDMonochorionic multiple pregnancies (MMPs) are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs.

METHODSUsing ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs (5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction). One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different indications. Data regarding the operations, complications and neonatal outcomes were analyzed.

RESULTSCord occlusions were successfully performed in 13/14 (93%) cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 (85%). Three operation-related complications occurred (21%), including membrane rupture of the terminated sac (1 case), preterm labor at 28 weeks gestation (1 case), and chorioamniotic membrane separation (1 case). Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin.

CONCLUSIONSThe application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited.

Adult ; Female ; Humans ; Postoperative Complications ; etiology ; Pregnancy ; Pregnancy Complications ; surgery ; Pregnancy Reduction, Multifetal ; methods ; Pregnancy, Multiple ; Umbilical Cord ; surgery

OBJECTIVETo analyse the effect of the reduction of multiple pregnancy through transvaginal ultrasonic monitoring on the pregnancy outcome.

METHODSEighty-four cases were divided into two groups according to whether they had vaginal hemorrhage before operation. And the pregnancy outcomes were analyzed.

RESULTSThe abortion rate and preterm birth rate of the vaginal hemorrhage group were higher, and the difference was statistically significant.

CONCLUSIONSThe reduction of multiple pregnancy through transvaginal ultrasonic monitoring is a safe operative method. But it is only a remedial treatment for multiple pregnancy, and how to prevent multiple pregnancy is of more practical value.

Adult ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal ; statistics & numerical data ; Pregnancy, Multiple ; statistics & numerical data ; Ultrasonography, Prenatal

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins