Improved results in multifetal pregnancy reduction: A report of 72 cases

Objective: To evaluate pregnancy outcome after either transabdominal or transvaginal multifetal pregnancy reduction. Design: A study of 72 consecutive multifetal pregnancy reductions. Setting: Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center Tel Hashomer, Israel. Patients: Seventy-two patients with multifetal pregnancies: 2 twins, 27 triplets, 26 quadruplets, 10 quintuplets, 3 sextuplets, 1 septuplet, 2 nontuplets, and one pregnancy with 12 fetuses. Intervention: Multifetal pregnancy reduction was performed at 9 to 13 weeks' gestation by either transabdominal or transvaginal potassium chloride injection. Main Outcome Measures: Early and late complications related to the procedure, outcome of pregnancy, and comparison of two periods. Results: Procedures performed between 1984 and 1989 (36 patients) were associated with a 33.3% pregnancy loss, whereas those performed between 1990 and 1992 (36 patients) were associated with no pregnancy loss. Of the 17 patients with quintuplets or more, 10 (59%) delivered live and healthy newborns. No difference was found when comparing the transabdominal and the transvaginal approaches. Conclusions: Both transvaginal and transabdominal approaches are comparable. There is a remarkable decrease in pregnancy loss with experience.