Objective: To assess the importance of amniotic fluid leakage in the early period (<14 days) after the fetal reduction procedure. Design: Prospective clinical study. Setting: Pregnant women who underwent fetal recuction to twins in an academic, tertiary perinatal department. Patients: Sixty triplet and 31 quadruplet pregnancies were identified before the ninth postmenstrual week of gestation. All patients underwent transabdominal multifetal pregnancy reduction to twins at 10 to 12 weeks of gestation. Early postprocedure premature rupture of membranes was defined as rupture of membranes of the sac on which the multifetal pregnancy reduction was performed within 14 days of the procedure. Interventions: Transabdominal multifetal pregnancy reduction from triplets and quadruplets to twins. Main Outcome Measure: Amniotic fluid leakage in the early period after fetal reduction. Results: Early PROM occurred in eight (13.3%) patients from the triplets group and in six (19.3%) patients in the quadruplet group. Three of 60 (5.0%) patients from the triplet group and 1 of 31 (3.2%) patients from the quadruplet group miscarried before 24 weeks gestation. However, none of these patients had had PROM during the early period after the procedure. Early PROM did not influence the incidence of premature contractions or delivery and the outcome of the liveborn infants. Two patients had a loss of one twin within 2 weeks from the reduction procedure, and 59% (99/169) of those who completed 24 gestational weeks delivered between 25 and 37 weeks. Conclusion: The presence of amniotic fluid leakage in the period close to the multifetal reduction procedure, although alarming, is not ominous for the remaining fetuses. We see no reason for any intervention in these patients.
- multifetal pregnancy reduction
- premature rupture of membranes