Selective reduction in multiple gestations

The frequency of multiple gestation has increased dramatically.Twins and higher order multiple gestations have pregnancies with increased risks for almost every complication of pregnancy, especially preterm labour, and congenital anomalies.Monochorionic twins, by virtue of the unique plasental angioarchitecture, are at risk for additional complications, such as severe discordant malformations, twin reversed arterial perfusion sequence, twin to twin transfusion syndrome or severe selective intrauterine growth restriction.These complications create unique challenges to those who manage multiple pregnancies.Reduction of higher order multiple pregnancies is on option to reduce pregnancy related risks and improve overall outcomes.Selective termination in complex monochorionic pregnancies can be life saving for the co-twin by preventing intrauterine demise or extreme prematurity.It is critical, however, to determine chorionicity before considering any approach to selective reduction.Procedures can carry out between 11 and 14 weeks allow for information to be obtained that can assist in selecting which fetus to terminate.Nuchal translucency screening can also be carried out before a reduction procedure.Risks for selective reduction are depend on many factors.Strong correlations were observed among the starting number of fetuses, the finishing number of fetuses, and the likelihood of poor pregnancy outcome, including both pregnancy losses and prematurity.Although it is clear that reduction of higher order multiples is of significant benefit, it is unclear whether the optimal number of remaining embriyos should be three,two or one.Although long term outcome information is not available, intutively it is reasonable to expect that less prematurity would result in healthier newborns.Reduction of triplets to singletons would not seem to be associated with a significant increased risk of pregnancy loss.
We aimed to show our triplet pregnancy case; monochorionic diamniotic twins and monochorionic singleton pregnacy in 12 weeks.It was an IVF pregnancy, 2 embriyos were transferred.Triplet pregnancy occured because of one embriyo was divided two.The parents were infertile for 5 years.They had to much stress about the abortion rate of the reduction procedure.We gave some information about the monochorionic twins possible complications such as twin to twin transfusion syndrome, selective IUGR and preterm labor.Then, they decided to reduction to single fetus. We measure dthe nuchal translucency, nasal bone and ductus venosus flow for each fetuses.Under ultrasound guidance by transabdominal approach, 22 gauge needle is positioned within the heart or thorax of the twins, and potassium chloride is injected.Now, the patient is in 28th weeeks without any complications.

Keywords

Multiple gestations, selective reduction

	File/Dsecription
	Figure 1 Triple pregnancy (monochorionic twins and singleton pregnacy)
	Figure 2 Triple pregnancy and determination of chorionicity
	Figure 3 Monochorionic twins and singleton pregnancy