Pregnancy: First trimester embryo reduction: a medical solution to an iatrogenic problem

The incidence of multiple pregnancies is increasing, mainlyas a consequence of the widespread use of various infertilityprotocols. Since such gestations present a high risk of feto—maternalmorbidity and mortality, selective first trimester fetocideremains one of the few reasonable options. We reviewed the literaturedealing with the outcome of 804 multiple pregnancies followingthe use of transcervical, transvaginal or transabdominal approaches.Questions relating to dealing with technical failure, methodof fetocide and procedural improvements are examined. In a comparisonof the variables: miscarriage, preterm delivery, perinatal andneonatal loss rates, the transvaginal approach fares better,but statistical significance (P < 0.001) is achieved onlyfor preterm delivery. We speculated that this might be attributableto the very early gestational age at which the procedure isusually performed. However, the transabdominal approach offersbetter results when post-manipulation maternal morbidity isconsidered, i.e. infection and vaginal bleeding. Since eachoption offers different advantages and disadvantages, additionalexperience and larger population samples are required to furtherclarify this important issue.