The number of multifetal pregnancies has increased dramatically as a result of the relatively widespread use of ovulation induction drugs and assisted reproductive technology(ART). In multifetal pregnancies, adverse outcome is directly
proportional
to
the number of fetuses within the uterus, primarily because of an increased predisposition to premature delivery. It is extremely difficult to counsel patients about the expected outcome of pregnancies involving three or more fetuses. To increase
the
chances of delivering infants mature enough to survive without being irreversibly damaged by the sequelae of marked prematurity, selective fetal reduction(SFR) to the smaller number of fetuses should be considered in multifetal pregnancies.
From July, 1993 to February, 1995, transvaginal selective fetal reduction in multifetal pregnancies were performed in 20 patients including 15 triplet, 4 quadruplet and 1 quientuplet pregnancies. Selective fetal resuction using intracardiac KCI
injection and aspiration of amniotic fluid was carried out in 8~11 weeks of gestation. After procedure 19 patients were remained as twin pregnancies, and 1 patients as singleton pregnancy. There have been 13 sets of twin delivery including 2
stillbirths
and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 5 cases in 36~37 weeks, and 1 cases in 30 weeks. Unfortunately, 2 stillbirths occurred in 20 weeks and 21 weeks of gestation, respectively, and 2 cases were aborted.
As
4
losses of twin pregnancies occurred, the delaye fetal loss rate in this selective fetal reduction was 25.0%(4/16). No fetal anomaly directly related to the procedure was encountered.
In conclusion, selective fetal resuction in multifetal pregnancies is a rather safe and ethically justified procedure that may improve the outcome of multiple pregnancies.
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