Multifetal pregnancy reduction: Evaluation of fetal growth in the remaining twins

Depp, Richard; Macones, George A.; Rosenn, Marc F.; Turzo, Elene; Wapner, Ronald J.; Weinblatt, Vivian

doi:10.1016/s0002-9378(96)70666-x

Cited by 51 publications

(28 citation statements)

References 14 publications

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“…For the group of singleton pregnancies and the spontaneous-reduction group, they found no differences for mean duration of pregnancies but described a lower birth weight for the survivors of spontaneous reduction (19). One study compared the outcome of reduced greater multiple pregnancies to twin pregnancies; this study showed that reduction does not reduce the incidence of intrauterine growth restriction in the remaining fetuses (20). As an interesting fact, several studies have assessed the risk of neurological sequelae in survivors of vanishing twin syndrome; these also reported controversial results (11,21).…”

Section: Discussionmentioning

confidence: 99%

Birth weight is lower for survivors of the vanishing twin syndrome: a case-control study

Shebl¹,

Ebner²,

Sommergruber³

et al. 2008

Fertility and Sterility

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Section: Discussionmentioning

confidence: 99%

Birth weight is lower for survivors of the vanishing twin syndrome: a case-control study

Shebl¹,

Ebner²,

Sommergruber³

et al. 2008

Fertility and Sterility

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“…In multifetal pregnancy reduction, Depp et al (1996) found a statistically significant trend toward increasing frequency of intrauterine growth restriction with increasing starting fetal number, and they were the first to suggest that early implantation crowding might adversely affect surviving singletons and twins of higher order pregnancies. Our findings of higher risk of adverse obstetric outcome in the intermediate survivor group versus singletons without spontaneous reduction support the hypothesis of placental impairment as a cause of spontaneous reduction in the second trimester.…”

Section: Comparison With Other Studiesmentioning

confidence: 89%

Consequences of Vanishing Twins in IVF/ICSI Pregnancies

Pinborg

Lidegaard

Freiesleben

et al. 2006

Obstetrical & Gynecological Survey

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BACKGROUND: Spontaneous reductions are a possible cause of the increased morbidity in IVF singletons. The aim of this study was to assess incidence rates of spontaneous reductions in IVF/ICSI twin pregnancies and to compare short-and long-term morbidity in survivors of a vanishing co-twin with singletons and born twins. METHODS: We identified 642 survivors of a vanishing co-twin, 5237 singletons from single gestations and 3678 twins from twin gestations. All children originated from pregnancies detected by transvaginal sonography in gestational week 8. By crosslinkage with the national registries the main endpoints were prematurity, birth weight, neurological sequelae and mortality. RESULTS: Of all IVF singletons born, 10.4% originated from a twin gestation in early pregnancy. Multiple logistic regression analyses adjusted for maternal age, parity and ICSI treatment showed for birth weight <2500 g an odds ratio (OR) of 1.7 [95% confidence interval (CI) 1.2-2.2] and for birth weight <1500 g OR 2.1 (95% CI 1.3-3.6) in singleton survivors of a vanishing twin versus singletons from single gestations; corresponding figures were seen for preterm birth. This increased risk was almost entirely due to reductions that occurred at >8 weeks gestation. We found no excess risk of neurological sequelae in survivors of a vanishing co-twin versus the singleton cohort; however, OR of cerebral palsy was 1.9 (95% CI 0.7-5.2). Furthermore, we observed a correlation between onset of spontaneous reduction, i.e. the later in pregnancy the higher the risk of neurological sequelae (r = -0.09; P = 0.02). Adjusted OR of child death within the follow-up period was 3.6 (95% CI 1.7-7.6) in the survivor versus the singleton cohort. CONCLUSIONS: One in 10 IVF singletons originates from a twin gestation. Spontaneous reductions that occur at >8 weeks gestation are one of the causes for the higher risk of adverse obstetric outcome in IVF singletons.

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“…Slowed midgestation fetal growth, in turn, has been significantly associated with preterm birth in singletons (35)(36)(37), twins (24), and triplets (38). Fetal reduction of triplets to twins has been associated with lower birthweight, shorter gestation, and greater birthweight discordancy (39)(40)(41)(42)(43)(44).…”

Section: Discussionmentioning

confidence: 99%