First-trimester transabdominal multifetal pregnancy reduction: a report of 85 cases
Article Abstract:
New reproductive technologies that utilize both drugs to stimulate ovulation and the transfer of multiple embryos (in vitro fertilization) have increased the chances of conceiving more than one fetus. A pregnancy of three or more fetuses runs the risk of causing high blood pressure, premature delivery, a complicated delivery and total pregnancy loss. To reduce the risks associated with more than three fetuses, a procedure can be used known as multifetal pregnancy reduction, which selectively reduces the number of fetuses. The procedure originally involved suctioning one or more fetal sacs by entering the vagina (transcervical aspiration), but this was abandoned because of increased bleeding and the potential loss of the entire pregnancy, and possible infection. The experience with selective fetal reduction performed by removing the embryonic sacs through the abdomen is reported. Transabdominal pregnancy reduction was performed on 85 women between 9.5 and 13 weeks of pregnancy. Under ultrasonographic guidance, a needle containing potassium chloride is inserted into the embryonic sac to achieve termination. In this study, there were 28 sets of triplets, 47 sets of quadruplets, four of quintuplets, four of sextuplets, one set of septuplets and one of nontuplets (nine fetuses). All of the reductions were successful in reducing all but five of the pregnancies to twins (four were reduced to triplets and one to a single fetus). There were 53 completed pregnancies, 45 of which delivered live infants while 8 lost the entire pregnancy 3.5 to 11 weeks after the procedure. The remaining 32 pregnancies had not yet delivered as of this report. The pregnancies continued for an average of 35.7 weeks; 16 women delivered after the 37th week of pregnancy (35.5 percent), 16 delivered between the 34.5th and 37th week (35.5 percent) nine delivered between the 32 and 34.5th week (20 percent) and four delivered before the 32nd week of pregnancy (nine percent). All the infants were born healthy except one, who was delivered early because of maternal high blood pressure. The infant affected by hyaline membrane disease (underdeveloped lung tissue) remains on a respirator eight months after delivery, while its twin remains healthy. There was no evidence that the eight lost pregnancies were the result of the procedures, since one occurred at 3.5 weeks and the remaining were lost six weeks later. Although there are many ethical issues surrounding pregnancy reduction, it can be argued that any attempt to improve fetal survival is reasonable. Until other methods to reduce the chances of conceiving more than three fetuses are found, multifetal pregnancy reduction is an important therapeutic option. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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Intrauterine intravascular transfusion for severe erythroblastosis fetalis: how much to transfuse?
Article Abstract:
Erythroblastosis fetalis is a complication of pregnancy caused by incompatibility between the maternal and the fetal blood. The mother's blood reacts to the fetus' blood as if it were foreign. This causes severe red blood cell destruction (anemia) in the fetus, and fetal fluid retention, known as hydrops fetalis. In severe cases the fetus can be given an intrauterine intravascular transfusion, a blood transfusion directly into the fetal blood circulation, while the fetus remains inside the uterus. Although the technique is preferred over transfusions directly into the fetal abdominal cavity, intraperitoneal transfusion, the amount of blood to be given and the timing of subsequent transfusions are uncertain. To determine the correct volume of packed red blood cells required during each transfusion, and the timing of subsequent transfusions, 28 fetuses requiring 81 transfusions were studied (one to six transfusions per patient). The goal of each treatment was to reach a hematocrit of 35 to 50 percent. Factors that were investigated for usefulness in determining transfusion volumes were the pre-transfusion hematocrit, the difference between the hematocrit before and after transfusion (hematocrit increase), the hematocrit of the donor blood, the age of the fetus, the estimated fetal weight, and the time since the previous transfusion. It was determined that the hematocrit increase and either the estimated fetal weight or the age of the fetus best predicted the amount of blood required at each transfusion. The adequacy of the transfusion is assessed by measuring the final post-transfusion hematocrit. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1990
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Selective second-trimester termination of the anomalous fetus in twin pregnancies
Article Abstract:
The decision to abort a fetus with a significant but nonlethal abnormality can be a morally difficult question for parents, but it is particularly so in the case of multiple pregnancies, when only one fetus is affected in such a way. In 17 cases of multiple pregnancies, the selective abortion of a deviant or defective (anomalous) fetus was conducted during the second trimester of pregnancy. In four of the first six cases, both fetuses were lost. As operator skills and technology improved, the results improved. Healthy infants were delivered in the next 11 cases. Intracardiac injection of potassium chloride was the most effective method, but it should not be used when the fetuses share the same chorionic sac, or outermost membrane of the embryo (monochorionic twin gestations).
Publication Name: Obstetrics and Gynecology
Subject: Health
ISSN: 0029-7844
Year: 1989
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