Journal article
Fetal reduction from twins to a singleton: A reasonable consideration?
Obstetrics and gynecology (New York. 1953), v 104(1), pp 102-109
01 Jul 2004
PMID: 15229007
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVE: In the past, our group took the position that we would not provide multifetal pregnancy reduction to a singleton regardless of starting number except for serious maternal medical indications or as a selective termination for diagnosed fetal anomalies. With evidence of increased safety and more women (many aged 40 years or more) asking for counseling about reduction to a singleton, we reviewed our prior reasoning.
METHODS: We compared outcomes of 52 first-trimester twin-to-singleton for multifetal pregnancy reduction cases performed by a single operator to twin and singleton data from recent national register studies.
RESULTS: Twin-to-singleton reductions represent less than 3% of all cases. Forty of 52 patients were aged 35 years or more, 19 were aged more than 40 years, and 2 were aged more than 50 years (age range 32–54 years). Since 1999, 23 of 28 had chorionic villus sampling before multifetal pregnancy reduction. Fifty-one of 52 reached viability with mean gestational age at delivery of 37.2 weeks. One of 52 patients miscarried (1.9%). Compared with multiple sources of data for twins, the loss rate is lower in twins reduced to a singleton.
CONCLUSION: Until recently, multifetal pregnancy reductions to a singleton were rare. Physicians were concerned about the unknown risks of multifetal pregnancy reduction in this situation. They also had moral doubts about the justification to go “below twins.” However, physicians know that spontaneous twin pregnancy losses average 8–10%. Also, with experience, multifetal pregnancy reduction has become very safe in our hands. Our data suggest that the likelihood of taking home a baby is higher after reduction than remaining with twins. We propose that twin-to-singleton reductions might be considered with appropriate constraints and safeguards.
LEVEL OF EVIDENCE: III
Metrics
Details
- Title
- Fetal reduction from twins to a singleton: A reasonable consideration?
- Creators
- Mark I Evans - Departments of Obstetrics & Gynecology, St. Luke's Rooisevelt Hospital Center, Columbia University, New York, United StatesMarion I Kaufman - Drexel UniversityAnita J Urban - Drexel UniversityDavid W Britt - Drexel UniversityJohn C Fletcher - University of Virginia
- Publication Details
- Obstetrics and gynecology (New York. 1953), v 104(1), pp 102-109
- Publisher
- Elsevier Science
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Obstetrics and Gynecology
- Web of Science ID
- WOS:000225414600016
- Scopus ID
- 2-s2.0-3242656392
- Other Identifier
- 991021886848804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology