Fetal reduction for everyone?

Mark I. Evans

doi:10.1016/j.bpobgyn.2022.04.003

2022-11-01

PRE

Mark I. Evans *

Jenifer Curtis

David W. Britt

DOI：10.1016/j.bpobgyn.2022.04.003

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摘要

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Infertility treatments have benefited millions of couples to have their own children; however, the complication of multiple pregnancies with their increased morbidity and mortality has created significant problems. Fetal reduction (FR) was developed to ameliorate these issues. Over 30 years of publications show that FR has been highly successful in substantially reducing both mortality and morbidity. As with most radically new techniques, initial cases were in the nothing to lose category. With experience, indications liberalize, and quality of life issues increase as a proportion of cases. Overall risks for twins are not twice as those for singletons, but they are approximately 4- to 5-fold higher. In experienced hands, the combination of genetic testing by CVS followed by FR has made most multiples behave statistically as if they were originally the lower number. The use of microarray analysis to better determine fetal genetic health before deciding on which fetus(es) to keep or reduce further improves pediatric outcomes. With increasing experience and lower average starting numbers, the proportion of FRs to a singleton has increased considerably. Twins to a singleton FR now constitute an increasing proportion of cases performed. Data on such cases show improved outcomes, and we believe FR should be at least discussed and offered to all patients with a dichorionic twin pregnancy or higher. eSET is not a panacea because of the resultant monochorionic twins. (c) 2022 Published by Elsevier Ltd.

Keyword:

Multiple pregnancy

Twins

Fetal reduction

CVS

Amniocentesis

Cerebral palsy

期刊

Best Practice and Research Clinical Obstetrics and Gynaecology

IF:

4.1

论文数:

2.0K

被引数:

6.2K

机构

Icahn School of Medicine at Mount Sinai

学者数:

4.6W

论文数: 3.4W

被引数: 58

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