Reducción embrionaria en embarazo gemelar / Embryo reduction in twin pregnancy

La reducción embrionaria es la interrupción selectiva del desarrollo de uno o varios fetos en el primer trimestre del embarazo. El embarazo gemelar se presenta aproximadamente en uno de cada 100 nacimientos y se considera como una entidad con alto riesgo materno y fetal. Los embarazos múltiples tienen un impacto mayor en los sistemas de salud, debido a la mayor frecuencia de complicaciones. La rotura prematura de membranas causa aproximadamente el 40 por ciento de los partos pretérmino y, como consecuencia, aportan un 10 por ciento de la mortalidad perinatal según la Sociedad Española de Ginecología y Obstetricia. En este caso clínico se observó que una actitud expectante con los pertinentes controles ecográficos (índice del líquido amniótico), analíticos (recuento leucocitario y reacción en cadena de la polimerasa) y clínicos (frecuencia cardiaca y temperatura) pueden llevar a una buena evolución posnatal que justificó al menos en esta ocasión, una actitud conservadora(AU)

Embryonic reduction is the selective interruption of the development of one or several fetuses in the first trimester of pregnancy. Twin pregnancy occurs in approximately one in every 100 births. It is considered an entity with high maternal and fetal risk. Multiple pregnancies have greater impact on health systems due to the higher frequency of complications. Premature rupture of membranes causes approximately 40 percent of preterm births and, consequently, it contributes 10 percent of perinatal mortality according to the Spanish Society of Gynecology and Obstetrics. In this clinical case it was observed that an expectant attitude with the relevant ultrasound (index of amniotic fluid), analytical (leukocyte count and polymerase chain reaction) and clinical (heart rate and temperature) controls can lead to good postnatal evolution, justified at least on this occasion, a conservative attitude(AU)

Perinatal outcome after multifetal pregnancy reduction.

OBJECTIVE: To assess multifetal pregnancy reduction in Indian context. METHODS: It is a retrospective descriptive study. Perinatal outcome of 92 multifetal pregnancies were retrieved from a well maintained database. Fetal reductions were carried out using standard protocol. RESULTS: There were 92 pregnancies referred for fetal reduction during the study period. Out of 92, twelve pregnancies (20.3%) had fetal or neonatal losses; of which complete pregnancy loss rate was 8.5% and partial pregnancy loss rate was 11.8%. Twenty one (35.6%) pregnancies had premature deliveries. The median birth weight was 2100 grams. Four babies were born alive with congenital anomalies. CONCLUSION: Our study showed the median birth weight, rates of pregnancy loss and prematurity after the fetal reduction procedure was comparable with other studies. However, it must be noted that the rate of loss to follow up was higher in our study.

Pregnancy Outcomes of Different Methods for Multifetal Pregnancy Reduction: A Comparative Study

The purpose of this study was to evaluate the outcomes of various methods of multifetal pregnancy reduction (MFPR) and to determine which method produces better outcomes. One hundred and forty-eight patients with multiple pregnancies resulting from assisted reproduction programs and underwent MFPR were included. According to the use of potassium chloride (KCl), patients were divided into 'KCl', and 'non- KCl' groups, and based on gestational age at the time of procedures, patients were divided into 'Early' (before 8 weeks of gestation) and 'Late' (at 8 weeks or later) groups. Firstly, to clarify the effect of each component of MFPR procedure, data were analyzed between 'KCl' and 'non-KCl' groups, and between 'Early' and 'Late' groups with adjustments. Secondly, comparison between 'Early, non-KCl' and 'Late, KCl' groups was performed to evaluate the combinative effect of both components. Non-KCl groups showed a significantly higher take-home-baby rate, and lower risk of extreme prematurity and preterm premature rupture of membranes (PPROM) than KCl groups. Early groups showed a lower immediate loss rate than Late groups. As compared with 'Late, KCl' group, 'Early, non-KCl' group was superior in terms of immediate loss, pregnancy loss, take-home-baby, and PPROM rates. Our data suggest that the 'Early, non-KCl' method may be a better option for MFPR.

Transabdominal fetal reduction in quadruplet pregnancy during first trimester: a case report.

Multifetal pregnancy reduction was performed in a patient with quadruplet pregnancy at the 12th week of gestation. Reduction of the fetuses to two was carried out by injecting potassium chloride solution into the fetal chest under transabdominal ultrasound guidance. No complications were encountered and the woman was delivered of healthy twins at 37 weeks of gestation.