Document Detail

Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies?
MedLine Citation:
PMID:  10027131     Owner:  NLM     Status:  MEDLINE    
This article reviews the arguments for the use of multifetal pregnancy reduction (MFPR) for the prevention of preterm deliveries in triplet and higher order multiple pregnancies and evaluates its effectiveness based on data from published studies. The arguments in favour of pregnancy reduction are based on the substantial mortality and morbidity associated with these pregnancies. Triplets and higher order multiples have increased rates of preterm delivery and intrauterine growth retardation, both of which are independent risk factors for death and handicap. Even controlling for gestational age, rates of mortality and handicap are higher for multiples than for singletons. Moreover, the family's risk of losing a child or having a handicapped child is greater because there are more infants at risk. MFPR effectively lowers these risk by reducing the frequency of preterm delivery. However, its effectiveness may be limited. In some studies, the proportion of preterm deliveries in reduced pregnancies remains above levels found in spontaneous twin or singleton pregnancies and MFPR does not appear to reduce the prevalence of low birth weight. Furthermore, the procedure itself has unwanted side effects: it increases the risk of miscarriage, premature rupture of the membranes and causes adverse psychological effects such as grief or depression for many patients. The authors note that a majority of the higher order multiple pregnancies result from a medical intervention in the first place, either through IVF techniques or the use of ovulation stimulation drugs. Although MFPR is an effective measure for reducing the substantial morbidity and mortality associated with higher order multiple pregnancies, preventive methods, such as limiting to 2 the number of embryos transferred for IVF and better control of the use of ovulation induction drugs, remain more effective and less intrusive.
E Papiernik; G Grangé; J Zeitlin
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of perinatal medicine     Volume:  26     ISSN:  0300-5577     ISO Abbreviation:  J Perinat Med     Publication Date:  1998  
Date Detail:
Created Date:  1999-04-22     Completed Date:  1999-04-22     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0361031     Medline TA:  J Perinat Med     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  365-70     Citation Subset:  IM    
Department of Obstetrics and Gynecology, University René Descartes, Paris, France.
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MeSH Terms
Fetal Death / prevention & control
Fetal Growth Retardation / prevention & control
Obstetric Labor, Premature / prevention & control*
Pregnancy Reduction, Multifetal* / psychology
Pregnancy, Multiple*
Risk Factors

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