Second-trimester multifetal pregnancy reduction facilitates prenatal diagnosis before the procedure

Objective: To evaluate the pregnancy outcome of selective second- trimester multifetal pregnancy reduction (MFPR) compared to first-trimester MFPR. Design: Cohort analysis. Setting: In Vitro Fertilization Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Patient(s): The study groups comprised 38 and 70 patients who underwent selective second-trimester MFPR (group 1) and first-trimester MFPR (group 2) at mean gestational ages of 19.7 ± 3.3 weeks and 11.7 ± 0.7 weeks, respectively. Intervention(s): Ultrasonographically guided intracardiac injection of potassium chloride (KCl) solution. Main Outcome Measure(s): Pregnancy outcome and obstetric complications. Result(s): No statistically significant difference was found between group 1 and group 2 regarding mean gestational age at delivery (35.4 ± 3.4 weeks and 35.9 ± 3.1 weeks, respectively); mean birth weight (2,318.9 ± 565.7 g and 2,138.1 ± 529.4 g); and the incidence of obstetric complications. These complications included pregnancy loss (5.2% and 15.7%), pregnancy-induced hypertension (0 and 10%), discordancy (12% and 18.4%), intrauterine growth restriction (0 and 40%), and gestational diabetes (0% and 6%). However, the rate of all pregnancy complications was lower among second- trimester MFPR patients. Conclusion(s): Selective second-trimester MFPR is associated with favorable perinatal outcome and may facilitate detection of structural and chromosomal anomalies before the procedure and selective reduction of the affected fetus. (C)2000 by American Society for Reproductive Medicine.