First-trimester multifetal pregnancy reduction: Acute and persistent psychologic reactions

Schreiner-Engel, Patricia; Walther, Virginia; Mindex, Janet; Lynch, Lauren; Berkowitz, Richard L.

doi:10.1016/0002-9378(95)90570-7

Cited by 99 publications

(46 citation statements)

References 12 publications

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“…For those who chose to reduce, they grieved about the child or children who might have been while those who declined to reduce wondered about which one of their children would not be with them if they had undergone reduction. This was consistent with other studies of psychological reactions to multifetal reduction (McKinney et al, 1996;Schreiner Engel et al, 1995).…”

Section: Discussionsupporting

confidence: 93%

We Didn't Deserve This: Bereavement Associated with Multifetal Reduction

Collopy¹

2002

Twin Research

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Section: Discussionsupporting

confidence: 93%

We Didn't Deserve This: Bereavement Associated with Multifetal Reduction

Collopy¹

2002

Twin Research

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“…By offering the procedure 'close to home' it is hoped that costs to the health care system may be reduced and, more importantly, that the sense of isolation and, therefore, the significant psychological morbidity following these procedures [4,5] will be minimized.…”

Section: Discussionmentioning

confidence: 99%

“…It has been justified ethically that reducing the total number of fetuses in both a high-order multiple pregnancy and a multiple pregnancy discordant for fetal anomaly results in a continuing pregnancy, with the provision of the least harm and the maximum benefits for both mothers and fetuses [1,2]. However, these procedures certainly provide no panacea [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Multifetal Pregnancy Reduction and Selective Termination: The Canadian Experience

Dadelszen

Johnson²,

Farquharson³

et al. 1999

Fetal Diagn Ther

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Objective: To describe the experience of two Canadian referral centres with multifetal pregnancy reduction (MFPR) and selective termination (ST). Methods: Retrospective chart review of all MFPR and ST procedures during the periods from January 1, 1990, to December 31, 1997 (Vancouver), and from September 1, 1995, to December 31, 1997 (Toronto). Outstanding outcome data were obtained by telephone. All women were managed according to standard protocols. Non-parametric analysis of continuous variables and Fisher’s exact test for categorical variables were used. Results: 61 women underwent transabdominal MFPR (n = 44) or ST (n = 17). Median maternal age: MFPR and ST 33.0 years; gestational age at reduction: MFPR 11.4, ST 20.2 weeks; procedure duration: MFPR 4, ST 10 min. 89% MFPR and 12% ST cases followed assisted reproduction. 7% MFPR and 18% ST pregnancies lost <24 weeks (n.s.). 97% MFPR and 83% ST non-reduced fetuses delivered alive. Median delivery gestational age: MFPR and ST 37 weeks. Conclusions: The results are similar to published series. This procedure has increased options for Canadian couples, offering the procedure ‘close to home’, reducing costs and, more importantly, the significant psychological morbidity following these procedures.

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“…We analyzed only quantitative aspects because the others (ethical, moral, legal and philosophical) were differently interpreted by each team using these procedures [16,17]. These considerations are essential in the induction of first-trimester multifetal pregnancy reduction but they were not consistantly reported in the literature [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Multifetal Pregnancy Reduction: Evaluation of Technical Aspects and Risks from 2,756 Cases in the Literature

Déchaud

Picot²,

Hédon³

et al. 1998

Fetal Diagn Ther

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Objective: To evaluate the technical aspects, efficacy and safety of first-trimester multifetal pregnancy reduction in the management of multifetal pregnancies, an analysis of the international literature on first-trimester multifetal pregnancy reduction was made. Materials: Thirty-three studies were selected from an international review of the literature. Total fetal loss rate, risk of fetal loss after the procedure with the different techniques and gestational age at delivery were the main parameters studied. The Kruskal-Wallis test and Mann-Whitney test were used for statistical analysis. Results: 2,756 multifetal pregnancy reductions were performed (2,145 transabdominal, 363 transcervical, and 248 transvaginal procedures). Total fetal loss rates were different: 16.7% for the transabdominal, 24.8% for the transcervical and 10.9% for the transvaginal procedure (p = 0.03). The risk of fetal loss was 12% for the transabdominal, 20% for the transcervical, and 10% for the transvaginal approach at less 24 weeks of gestation (p = 0.04). There was no difference for the gestational age at the time of the procedure, the initial and final number of embryos, and the gestational age at delivery. Conclusion: Because the transvaginal approach seems to be the safer procedure, surgeons may opt for it. The transcervical approach has a high fetal loss rate and should be excluded.

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First-trimester multifetal pregnancy reduction: Acute and persistent psychologic reactions

Cited by 99 publications

References 12 publications

We Didn't Deserve This: Bereavement Associated with Multifetal Reduction

We Didn't Deserve This: Bereavement Associated with Multifetal Reduction

Multifetal Pregnancy Reduction and Selective Termination: The Canadian Experience

First-Trimester Multifetal Pregnancy Reduction: Evaluation of Technical Aspects and Risks from 2,756 Cases in the Literature

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