Multifetal pregnancy reductions and selective fetocide in a tertiary referral center – a retrospective cohort study

Riina Maria Jernman; Vedran Stefanovic

doi:10.1515/jpm-2023-0414

Article

Multifetal pregnancy reductions and selective fetocide in a tertiary referral center – a retrospective cohort study

Riina Maria Jernman and Vedran Stefanovic

Published/Copyright: January 29, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 3

Abstract

Objectives

Multiple pregnancies involve several complications, most often prematurity, but also higher anomaly rates. Reducing fetuses generally improves pregnancy outcomes. We conducted this study to evaluate the obstetrical and neonatal results after multifetal pregnancy reduction (MFPR) in the largest tertiary hospital in Finland.

Methods

This retrospective cohort study included all MFPR managed in Helsinki University Hospital during a 13 year period (2007–2019). Data on pregnancies, parturients and newborns were collected from patient files. The number of fetuses, chorionicities and amnionicities were defined in first-trimester ultrasound screening.

Results

There were 54 MFPR cases included in the final analyses. Most often the reduction was from twins to singletons (n=34, 63 %). Majority of these (25/34, 73.5 %) were due to co-twin anomaly. Triplets (n=16, 29.6 %) were reduced to twins (n=7, 13 %) or singletons (n=9, 16.7 %), quadruplets (n=2, 3.7 %) and quintuplets (n=2, 3.7 %) to twins. Most (33/54, 61.1 %) MFPR procedures were done by 15+0 weeks of gestation. There were six miscarriages after MFPR and one early co-twin miscarriage. In the remaining 47 pregnancies that continued as twins (n=7, 14.9 %) or singletons (n=40, 85.1 %) the liveborn rate was 90 % for one fetus and 71.4 % for two fetuses.

Conclusions

Most MFPR cases were pregnancies with an anomalous co-twin. The whole pregnancy loss risk was 11.1 % after MFPR. The majority (70.6 %) of twins were spontaneous, whereas all quadruplets, quintuplets, and 56.3 % of triplets were assisted reproductive technologies (ART) pregnancies. Careful counselling should be an essential part of obstetrical care in multiple pregnancies, which should be referred to fetomaternal units for MFPR option.

Keywords: multifetal; reduction; triplets; twins; pregnancy; fetocide

Corresponding author: Vedran Stefanovic, Professor, Vice-President of the IAPM Educational Committee, Department of Obstetrics and Gynecology, Fetomaternal Medical Center Helsinki University Hospital and University of Helsinki, Helsinki, Finland, Phone: +358 50 427 1230, E-mail: vedran.stefanovic@hus.fi.

Acknowledgments

Research nurse Eija Kortelainen is acknowledged for her valuable work in data collection for this project.

Research ethics: This study has been approved by the authors’ Institutional Review Board (Helsinki University Hospital, Obstetrics and Gynecology). Regarding ethical approval, the local Institutional Review Board deemed the study exempt from review.
Informed consent: Not applicable.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission. V. Stefanovic has designed the study and has commented and approved the final version. R. Jernman has designed the data collection form, analyzed the data and written the manuscript with V. Stefanovic.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The data of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy and ethical restrictions.

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Received: 2023-10-04

Accepted: 2023-12-23

Published Online: 2024-01-29

Published in Print: 2024-03-25

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0414

Keywords for this article

multifetal; reduction; triplets; twins; pregnancy; fetocide