Preterm delivery and growth restriction in multifetal pregnancies reduced to twins |
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Authors: | Sebire NJ; Sherod C; Abbas A; Snijders RJ; Nicolaides KH |
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Institution: | Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK. |
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Abstract: | Gestation at delivery, birthweight and pregnancy outcome of surviving
fetuses from 127 multifetal pregnancies undergoing embryo reduction to
twins were compared to 354 chromosomally normal non-reduced dichorionic
twin pregnancies. First-trimester embryo reduction was carried out by
intracardiac injection of KCl. In 16 (12.6%) of the 127 multifetal
pregnancies reduced to twins, there was miscarriage of both fetuses before
24 weeks of gestation. The median interval between reduction and fetal loss
was 5 weeks (range 1-12). In livebirths, the median gestation at delivery
was 36 weeks (range 24-41) and the median difference in birthweight from
the appropriate mean was -0.94 SD (range -3.89-1.73 SD). Both fetal loss
before 24 weeks and the interval between embryo reduction and delivery were
significantly associated with the gestation at reduction (r = 0.40, P <
0.001 and r = -0.57, P < 0.001 respectively). In the pregnancies reduced
to twins compared to the non-reduced twins, the percentage of miscarriages
was higher (12.6 compared to 2.5%; chi 2 = 19.2, P < 0.001), the median
gestation at delivery was lower (36 compared to 37 weeks; t = -1.74, P <
0.05), and the median birthweight deficit was greater (-0.94 compared to
-0.65 SD: t = -4.1, P < 0.001).
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