Safety Of Multi Foetal Pregnancy Reduction : A Tertiary Care Centre Based Prospective Cohort Study

Abstract

Introduction: The incidence of multifoetal pregnancies has increased significantly in the recent years due to increased use of artificial reproductive technique (ART). Higher-order multiple pregnancies are associated with increased incidences of pregnancy complications mainly abortions, pre-eclampsia, preterm delivery, and foetal death. Multifoetal reduction (MFR) during first trimester and subsequent delivery of twins or singleton can reduce pregnancy associated morbidities. This study was conducted to evaluate the complications and pregnancy outcomes of transabdominal ultrasound guided foetal reduction technique.

Material & Method: It was a prospective cohort study of the past 3 years i.e., from May 2019 to May 2022.Multifoetal pregnancy reduction was carried out in107 patients, at 11 to 12 weeks of gestational age after assessment of NT/NB and chorioniciy. Foetal reduction(FR) was done using 2mEq/mL of KCl, 0.5 – 2 ml solution was injected intracardiac/Intra thoracic into foetus under the guidance of trans abdominal ultrasound and the pregnancies were followed till delivery to observe for complications .

Results: The study included 107 multi foetal pregnancies which underwent MFR. 93.4% of reduction were done due to higher order pregnancy. Among them 53.3% were reduced from triplet to twin. 6.54% patients underwent foetal reduction for anomaly in co-foetus. 81.40% of patient were primigravida and 68.22 % of patients conceived through IVF. More than half of the patients were above the age of 30 years. The average time required for the foetal reduction was 4 to 5 minutes. The most common complication related to the procedure was leakage of amniotic fluid from the reduced sac which occurred in 8.40% of cases. 1.86% of cases had abortion within 2 weeks of procedure. Regarding pregnancy outcomes, the study had 4.6% (n=5) delayed abortions before 20 weeks period of gestation.  82.40% patients underwent caesarean delivery, With a mean gestational age of 35.1 weeks at the time of delivery. The average new-born weighed 1860 g, the live birth-rate was 91.76% ,78.2% of them needed to be admitted to the NICU and most of them made successful recovery.

Conclusions: Transabdominal ultrasound guided foetal reduction is an effective technique in preventing maternal and foetal complications of higher order pregnancy but with a 1-2 % risk of procedure related abortion.