Risks and pregnancy outcome after fetal reduction in dichorionic twin pregnancies: a Danish national retrospective cohort study

Kristensen, S E; Ekelund, Charlotte Kvist; Sandager, Puk; Jørgensen, Finn Stener; Hoseth, Eva; Sperling, L.; Balaganeshan, Sedrah Butt; Hjortshøj, Tina Duelund; Gadsbøll, Kasper; Wright, Mr. Alan; Wright, Mr. David; McLennan, Andrew; Sundberg, Karin; Petersen, Olav Bjørn

doi:10.1016/j.ajog.2022.10.028

Cited by 15 publications

(5 citation statements)

References 33 publications

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“…Zemet et al ( 12 ) found in a cohort of 248 fetal reduction cases that those undergoing fetal reduction at 11–14 weeks had lower rates of pregnancy loss (0.6% vs. 1.3%), preterm delivery (pregnancy loss not included) <32 weeks (1.8% vs. 8.0%) and <34 weeks (1.8% vs. 12.0%) than those undergoing fetal reduction at approximately 15–23 weeks, though they found that the GA at delivery was not different from the GA at surgery ( 12 ). Another most recent study of 172 selective reduction cases, Kristensen et al reported that those undergoing surgery before 14 weeks had a lower rate of adverse pregnancy outcome (miscarriage, stillbirth), preterm birth <28 and <32 weeks (pregnancy loss not included), compared with those reduced after 14 weeks (1.4% vs. 6.1%; 0% vs. 4.3%; 2.8% vs. 5.4%, respectively) ( 20 ). The loss rate and preterm delivery rates from the above-mentioned studies were comparable to those in our study; however, the preterm delivery rate in the study of Zemet and Kristensen was lower than the result of this study.…”

Section: Resultsmentioning

confidence: 99%

Perinatal outcome and timing of selective fetal reduction in dichorionic diamniotic twin pregnancies: a single-center retrospective study

Zou,

Ji,

Chen

et al. 2024

Front. Med.

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ObjectiveThe study aimed to evaluate the pregnancy outcomes of dichorionic diamniotic twin pregnancies that were reduced to singletons at different gestational ages.Study designThis was a retrospective cohort study of twin pregnancies that underwent fetal reduction to singletons in a single tertiary referral center between 2011 and 2020. A total of 433 cases were included. The cohort was divided into five groups according to gestational age at surgery: Group A: <16 weeks (125 cases); Group B: 16–19+6 weeks (80 cases); Group C: 20–23+6 weeks (74 cases); Group D: 24–26+6 weeks (48 cases); and Group E: ≥27 weeks (106 cases). Outcome data were obtained by reviewing the electronic medical records or interviews.ResultsSelective reduction was technically successful. The clinical characteristics of the population were not different. The overall live birth rate and the survival rate were 96.5 and 95.4%, respectively. Although the rate of spontaneous miscarriage was comparable, gestational age at delivery significantly differed among groups (p < 0.001). Additionally, there was a trend that gestational age at delivery decreased with the increasing gestational age at surgery in Groups A, B, C, and D, whereas gestational age at delivery in Group E was later than that in Group D. In Groups A, B, C, and D, the rates of preterm birth at <32 weeks and <34 weeks increased with the increasing gestational age at surgery, while the rates in Group E were significantly lower than that in Group D. Regression analysis showed that timing of reduction may be an independent factor after adjusting for maternal age, parity, pre-pregnancy BMI, ART, and cervical length.ConclusionSelective reduction performed by experienced hands for a dizygotic abnormal twin is safe and effective. Gestational age at surgery (<26+6 weeks) was inversely correlated with gestational age at delivery and positively with the rate of preterm birth. Reduction after 27 weeks, where legal, can be performed with a good outcome for the retained fetus.

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Section: Resultsmentioning

confidence: 99%

Perinatal outcome and timing of selective fetal reduction in dichorionic diamniotic twin pregnancies: a single-center retrospective study

Zou,

Ji,

Chen

et al. 2024

Front. Med.

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“…Kristensen et al in 11 years cohort study about dichorionic-diamniotic twin pregnancies that undergone fetal reduction. They reported that this procedure was safe with good outcome for remaining co-twin and they showed that best results was taken when the procedure performed before 14 weeks they reported 19.4% preterm delivery rate before 37 weeks when reduction was performed at GA >14 weeks and 6.9% when reduction was performed before 14 weeks ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcome After Selective Fetal Reduction in Dichorionic Twin Pregnancies

Rahimi Sharbaf,

Shafaat,

Lashgari

et al. 2023

JFRH

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Objective: This study was conducted for determining pregnancy outcome after selective fetal reduction in twin pregnancies based on the gestational age at the time of the procedure in a referral academic center between 2017 and 2021. Materials and methods: This retrospective cohort study included all women with twin pregnancies who were diagnosed with a genetic or structural anomaly of one fetus or a desire to reduce the number of fetuses in order to reduce pregnancy complications visited in the period of 2017-2021. Reduction was performed due to an abdominal approach at 11 to 23 weeks of pregnancy. Maternal and pregnancy information were recorded. Results: A total of 159 cases of twin dichorionic pregnancies were included. The highest frequency of reduction was performed at the gestational age of 18-20 weeks, and the most common cause of reduction was major structural anomalies in the fetus .The results showed the average gestational age (GA) at the time of delivery to be 37.6 weeks, the average birth weight of 2,999 grams, the incidence of miscarriage (loss before 22 weeks) to be 9.4% and a rate of preterm birth (delivery before 37weeks) of 33.3%. There is not a statistically significant relationship between the gestational age at the time of reduction and preterm birth, the birth weight, the incidence of RDS and the incidence of SGA. Conclusion: Fetal reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks). It causes an increase in birth weight and perinatal outcome in remaining co-twin so we recommend fetal reduction after counselling with patients for their unique situation to improve pregnancy outcome.

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“…A study noted that asystole could be observed within one to two minutes of KCl injection, with immediate post-procedural complications, including maternal pain, leaking, and bleeding, which was conservatively managed [ 42 ]. Importantly, it is highlighted that potassium supplementation is unlikely to adversely affect the fetus without inducing maternal toxicity [ 43 ]. Furthermore, the application of KCl for fetal reduction is recognized as an effective and safe method for inducing fetal demise [ 25 ].…”

Section: Reviewmentioning

confidence: 99%

Fetal Reduction by Potassium Chloride Infusion in Unruptured Heterotopic Pregnancy: A Comprehensive Review

Agrawal,

Reddy,

Patel

et al. 2024

Cureus

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This comprehensive review explores the practice of fetal reduction through potassium chloride infusion in unruptured heterotopic pregnancies. Heterotopic pregnancies, characterized by the simultaneous occurrence of intrauterine and extrauterine gestations, present unique challenges in reproductive medicine. The review defines fetal reduction and underscores its significance in mitigating risks associated with heterotopic pregnancies, including the threat of rupture, maternal morbidity, and adverse outcomes. The analysis encompasses the background, methods, efficacy, ethical considerations, and future directions related to the procedure. Findings highlight the efficacy and safety of potassium chloride infusion, emphasizing the importance of proper patient selection and counseling. Implications for clinical practice underscore the procedure's viability in specific cases where the benefits outweigh the associated risks. The review concludes with recommendations for future studies, encouraging further research on procedural techniques, alternative methods, and the psychosocial impact on patients. This work is a foundation for advancing the management of unruptured heterotopic pregnancies, providing insights for clinicians and researchers to improve clinical outcomes and patient care.

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Risks and pregnancy outcome after fetal reduction in dichorionic twin pregnancies: a Danish national retrospective cohort study

Cited by 15 publications

References 33 publications

Perinatal outcome and timing of selective fetal reduction in dichorionic diamniotic twin pregnancies: a single-center retrospective study

Perinatal outcome and timing of selective fetal reduction in dichorionic diamniotic twin pregnancies: a single-center retrospective study

Pregnancy Outcome After Selective Fetal Reduction in Dichorionic Twin Pregnancies

Fetal Reduction by Potassium Chloride Infusion in Unruptured Heterotopic Pregnancy: A Comprehensive Review

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