A comparison among three ultrasound-guided transvaginal embryo reduction techniques in multifetal pregnancy / 中国微创外科杂志

ABSTRACT

Objective To compare clinical effects among three techniques of multifetal pregnancy reduction(MFPR) guided by transvaginal ultrasonography through vaginal approach.Methods Under the guidance of transvaginal B-ultrasonography,99 cases of multiple pregnancy following assisted reproductive technique underwent three different methods of embryo reduction drug injection directly to the pregnancy sac(Drug Group),simple embryonic bud aspiration(Aspiration Group),and combined use of drug and aspiration(Combination Group).Results The gestational age at the procedure ranged 41~88 days(mean,58.9?8.7 days).The success rate of the procedure on one session was 100%(99/99).Short-term outcomes included 3 cases of abortion(3.0%).On continuing follow-up observations in 73 cases,the incidences of abortion and premature delivery were 11%(8/73) and 12%((9/73)),respectively.No statistical differences were seen among the three groups in rates of abortion,premature delivery,and full-term delivery(?~2=1.131,P=0.889).In the Aspiration Group,however,the exposure time to B-ultrasound and the operative time were significantly shorter than those in the other two groups.The gestational age at the procedure was 61.7?8.2 days in the Drug Group,48.8?2.7 days in the Aspiration Group,and 56.7?7.2 days in the Combination Group,respectively,with significant differences between the Aspiration Group and other two groups(F=19.36,P=0.000).The number of embryos reduced was associated with pregnancy outcomes: the abortion rate was remarkably higher in patients receiving the reduction of more than two embryos than only one embryo(?~2=6.415,P=0.040).Conclusions Ultrasound-guided multifetal pregnancy reduction is a safe,effective and microinvasive procedure.It is recommended that simple embryonic bud aspiration be used for multifetal pregnancy before 7 gestational weeks,combined use of drug injection and aspiration for multifetal pregnancy at 7~9 gestational weeks,and drug injection to the pregnancy sac for multifetal pregnancy after 9 weeks.