Clinical Results of Transvaginal Multifetal Pregnancy Reduction According to the Gestational Period / 대한산부인과학회잡지

OBJECTIVE: To compare the pregnancy outcomes of transvaginal multifetal pregnancy reduction (MFPR) according to the gestational period when the procedure was performed METHODS: From January l995 to February 1998, total 27 patients with multiple pregnancy were included in this study. The patients were grouped to early MFPR group (8 weeks, n=ll) according to the gestational age that MFPRs were performed. All MFPRs were performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The complete pregnancy loss rate before 24 weeks of gestation, spontaneous loss of embryo, procedure-related complication, gestational age at delivery, and pregnancy complication were compared between the two groups. Statistical analysis of data was performed using Students t-test and Fishers exact test as appropriate. Statistical significance was defined as p<0.05. RESULTS: There was no significant difference in the complete pregnancy loss rate between the early MFPR group (6.3%) and the delayed MFPR group (27.3%). The incidence of partial spontaneous loss of embryo in the two groups were not differed significantly (6.3% vs. 18.2%). The procedure-related complication of the delayed MFPR group (36.4%) seemed to be higher than that of the early MFPR group (6.3%), however there was no statistical difference (p=0, 07). Especially, all 3 patients in whom the MFPR was performed after 10 weeks suffered from the procedure-related complication. The mean gestational age at delivery of the two groups were not differed significantly (36.3+2.8 weeks vs. 37.0+1.3 weeks). There was also no significant difference in the mean birth weights of the two groups (2378.8+563.7 gm vs. 2427.1+436.2 gm). CONCLUSION: Although there was no statistically significant difference, the early transvaginal MFPR might be a safe and useful method without significant adverse complications compared to the delayed MFPR.

Perinatal Outcome in Twin Pregnancies after in Vitro Fertilization and Embryo Transfer : Comparison between Reduced and Non-reduced Twins / 대한산부인과학회잡지

Multifetal pregnancy reduction(MFPR) has been suggested to improve pregnancy outc-ome in multifetal pregnancies with three or more fetuses after assisted reproductive techn-ology(ART) such as IVF-ET program, and now it seems to be a rather safe and effective mothod to reduce perinatal loss associated with multifetal pregnancies. To investigate the effectiveness of MFPR, the perinatal outcome of twin pregnancies in IVF-ET patients was analyzed in 3 groups : Group I-12 infertile patients who had conceived more than quadru-plet pregnancy and underwent MFPR to twin pregnancy, Group II-29 patients who had conceived triplet pregnancy and underwent MFPR to twin pregnancy, and Group III-30 pat-ients who had conceived twin pregancy initially and served as control group. Among 3 gr-oups, fetal loss rate before 24 weeks of gestation, pregnancy non-reduced, complications, gestational age at delivery, and birth weight were compared. Fetal loss rate after MFPR was significantly higher in Groups I(41.7%) and Group II(17.2%) compared with Group III(3.3%), and positively correlated with the number of fetuses before MFPR in Groups I and II. However, pregnancy complication rate was not significantly different among 3 groups(41.7%, 48.3%, and 36.7%). After exclusion of fetal loss cases before 24 weeks, mean gestational age at twin delivery and mean birth weight were not significantly different among 3 groups(36.2 weeks, 36.6 weeks, and 36.1 weeks ; 2.37 kg, 2.45 kg and 2.47kg).In conclusion, MFPR in multifetal pregnancies is an ethically justified procedure that may improve perinatal outcome in cases of multifetal pregnancies.