The induction of grand multiple gestation is a known complication of infertility treatment. Various studies show that the incidence of multiple gestation as a complication of induced ovulation therapy in infertile patients ranges from 16% to 39%.
Although there is a good deal of information about the gestation of twins, there is very little on triplets, and virtually nothing but case reports have been published on pregnancies involving four or more fetuses. There are so many complications
as
high fetal and neonatal mortality rate(31% in triplets, 43% in quadruplets and 91% in sextuplets), abortion, preterm labor, pregnancy-induced hypertension, premature rupture of membrane, post-partum hemorrhage, anemia and so on.
Without any intervention, an extremely poor prognosis could be expected for viable pregnancies in the multiple gestation Thus, we believed that an attempt to reduce the number of fetuses to a manageable number was the best possibility for a
successful
pregnancy outcome.
We performed the selective termination (selective reduction) at first trimester (6 to 13 weeks of gestation) for 10 patients, 9 treated with human menopausal gonadotropin and 1 occurred naturally.
Using the transvaginal sonography, we carried out cardiac puncture in all cases, and after then, we injected the fetal heart in five cases, injected the KCI solution in three cases and exanguinated the intracardiac blood in two cases.
In 5 of the 10 cases, the pregnancies continued to near term without problems and resulted in the delivery of healthy babies. In 3 of the 10 cases, the pregnancy continued wihtout problems for more than 20 weeks of gestation. Septic abortion was
occurred just after procedure in 1 case and spontaneous incomplete abortion was developed 4 weeks after procedure in another 1 case.
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