Selective termination: clinical experience and residual risks

Article Abstract:

Pregnancies of more than three fetuses are associated with a poor pregnancy outcome. The more fetuses, the greater the chances of complications. Although more than three fetuses rarely occur naturally, reproductive technology has increased the chances of multiple fetus pregnancies. In some cases, previously infertile couples are faced with a difficult decision of whether to terminate the entire pregnancy, or continue with all the fetuses. However, pregnancies having six or more fetuses have very low infant survival rates. In an effort to improve survival of multiple gestation fetuses, a procedure which selectively terminates one or more fetuses provides hope to couples when another conception is not always guaranteed. The experience of selective termination is reported for 22 couples with multiple gestations. The procedure involves locating the fetuses very early in the pregnancy (in the 10th or 11th week of pregnancy) with ultrasonographic imaging. Termination is achieved by injecting potassium chloride into the embryo's chest cavity, thereby producing mechanical disruption and embryo death. This procedure was performed on one octuplet (eight embryos), five quintuplet (five embryos), 12 quadruplet (four embryos), and four triplet pregnancies. All the selective terminations were uneventful and successfully performed. Twenty-one out of the 22 pregnancies were reduced to twins; one set of quadruplets was reduced to triplets. Five patients lost the entire pregnancy after the procedure (one loss occurred one week after the procedure, and the other four occurred later in the pregnancy). Eight sets of twins and two single fetus pregnancies were delivered. Seven sets of twins are still in progress. The overall pregnancy loss rate was five out of 22, or 22.7 percent. The termination procedure may be performed as early as six to seven weeks, but early spontaneous loss of embryos is not uncommon with multiple embryos, which increases the difficulty of the decision. Also, misdiagnosis is always a possibility. It is suggested that the transabdominal approach (needle insertion through the abdomen, rather than through the vagina and cervix) be performed between the 9th and 11th week of pregnancy. Multiple gestations should be reduced to twins for the most ethically sound and medical safe reduction. Selective termination is not a definitive answer for the unfortunate consequences of reproductive technology, but is a temporary solution until infertility treatments are improved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Pregnancy, Complications of, Pregnancy complications, Multiple birth, Reproductive technology, Pregnancy, Unwanted, Unwanted pregnancy

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Multifetal pregnancy reductions of triplets to twins: comparison with nonreduced triplets and twins

Article Abstract:

Reducing a triplet pregnancy to a twin pregnancy can reduce the risk of prematurity and low birth weight as well as other complications. The use of infertility drugs has increased the number of multifetal pregnancies. Researchers compared the outcome of triplet pregnancies, triplet pregnancies that had been reduced to twin pregnancies, and normal twin pregnancies. Compared to triplet pregnancies, both normal twin pregnancies and triplet pregnancies reduced to twin pregnancies had lower premature birth rates, higher birth weights, greater age at birth and lower miscarriage rates.

Health aspects, Infants (Newborn), Newborn infants, Twins, Pregnancy, Multiple, Multiple pregnancy, Triplets

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Age-specific variation in aneuploidy incidence among biochemical screening programs

Article Abstract:

Biochemical screening may detect higher rates of Down syndrome in high-risk age groups than expected by the Cuckle model. According to 96,148 prenatal screening results, researchers found significantly more cases of Down syndrome in 35-year-old to 39-year-old women than would be expected by Cuckle estimates. The findings with respect to women less than 29 years old did not differ from the Cuckle calculations.

Models, Diagnosis, Demographic aspects, Genetic screening, Genetic testing, Down syndrome, Aneuploidy

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