Transvaginal embryo aspiration—a safe method for selective reduction in multiple pregnancies

There has been a marked increase in the prevalence of twins, triplets and higher-order multiple pregnancies over the last 20 years due, in part, to delayed childbearing, but more significantly associated with the widespread introduction of assisted reproductive techniques. Once viability is confirmed these pregnancies pose a series of unique challenges to the obstetrician as the dynamic of the maternal – fetal relationship changes when there are two, or more, fetuses to consider. With the exception of postmaturity, all obstetric complications are more common in multiple pregnancies. Australian data shows perinatal mortality rates of 7, 25 and 63 per 1,000 births for singleton, twin (RR 3.4) and triplet (RR 8.5) pregnancies respectively; with similar rates reported in the UK and USA. While multiple pregnancies account for only 2% of births, they account for 20% of neonatal admissions and 12% of perinatal deaths – with a 5-fold increase in deaths before 1 year of age.

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OP05.14: Interstitial intrafetal laser for selective and non-selective reduction in complicated monochorionic multiple pregnancies

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.3178 ◽

2006 ◽

Vol 28 (4) ◽

pp. 452-453

Author(s):

L. Pasquini ◽

O. Barigye ◽

L. C. Chappell ◽

T. Vanderheyden ◽

P. Galea ◽

...

Keyword(s):

Selective Reduction ◽

Multiple Pregnancies

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A rare case of triplet pregnancy with three different fates of each conceptus

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v11i2.17465 ◽

2017 ◽

Vol 11 (2) ◽

pp. 56-58

Author(s):

Sayanti Paul ◽

S Mandal ◽

M Upadhyaya ◽

SR Pramanik

Keyword(s):

Rare Case ◽

Intrauterine Insemination ◽

Selective Reduction ◽

Controlled Ovarian Hyperstimulation ◽

Infertility Treatment ◽

Multiple Pregnancies ◽

Triplet Pregnancy ◽

Singleton Pregnancy ◽

Spontaneous Reduction ◽

Live Baby

Rate and number of multifetal gestations have increased dramatically largely due to infertility therapy. A number of pregnancies are multifetal to start with followed by spontaneous reduction of one or more embryos. The final outcomes of such pregnancies vary in relation to zygosity, chorionicity and gestational age. In this case report we present a triplet pregnancy resulting from controlled ovarian hyperstimulation followed by intrauterine-insemination in a primarily infertile patient and how it ended up into a singleton pregnancy with no conscious attempts at selective reduction or selective termination. While fighting with problem of multiple pregnancies which comes along with the widespread infertility treatment nature has its own miraculous way to get rid of such. Little patience and watchful expectancy from the part of obstetrician can achieve a healthy live baby without inadvertent complication.

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Selective reduction and termination of multiple pregnancies

Seminars in Fetal and Neonatal Medicine ◽

10.1016/j.siny.2010.08.002 ◽

2010 ◽

Vol 15 (6) ◽

pp. 327-335 ◽

Cited By ~ 52

Author(s):

R.C. Wimalasundera

Keyword(s):

Selective Reduction ◽

Multiple Pregnancies

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Selective reduction in twins and multiple pregnancies

Journal of Perinatal Medicine ◽

10.1515/jpm.2010.114 ◽

2011 ◽

Vol 39 (1) ◽

Cited By ~ 14

Author(s):

Aris Antsaklis ◽

Eleftherios Anastasakis

Keyword(s):

Selective Reduction ◽

Multiple Pregnancies

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Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Fetal Diagnosis and Therapy ◽

10.1159/000355406 ◽

2013 ◽

Vol 34 (4) ◽

pp. 211-216 ◽

Cited By ~ 11

Author(s):

Jing Lu ◽

Yuen Ha Ting ◽

Kwok Ming Law ◽

Tze Kin Lau ◽

Tak Yeung Leung

Keyword(s):

Radiofrequency Ablation ◽

Selective Reduction ◽

Multiple Pregnancies

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A cohort study of the perinatal outcome of radiofrequency ablation in complicated monochorionic multiple pregnancies based on a different needle insert angle

Journal of International Medical Research ◽

10.1177/03000605211018432 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110184

Author(s):

Qian Liu ◽

Xiaomei Shi ◽

Liyuan Fang ◽

Tengzi Rao ◽

Lishuang Shi ◽

...

Keyword(s):

Cohort Study ◽

Radiofrequency Ablation ◽

Gestational Age ◽

Cox Model ◽

Selective Reduction ◽

Needle Insertion ◽

Multiple Pregnancies ◽

Historical Cohort ◽

Fetal Survival ◽

Insertion Angle

Objective To compare the pregnancy outcomes of radiofrequency ablation (RFA) for complicated multiple pregnancies between fetal abdominal and dorsal needle insertion angles. Methods We performed a historical cohort study of patients who underwent selective reduction using RFA through different needle insertion angles from 2015 to 2018 at a local hospital. Dorsal needle insertion cases were consecutively selected and abdominal needle insertion cases were selectively enrolled. The Cox proportional hazards model was constructed to identify predictors of fetal survival time with different needle insertion angles. Results The RFA procedure was performed in 28 women through an abdominal insertion angle and in 28 women through a dorsal insertion angle. There were no significant differences in perinatal outcomes between the two groups. The overall live birth rate after RFA in the two groups was 73.5% and the mean gestation was 31.6 ± 6.5 weeks. The Cox model showed that gestational age at RFA was a predictor of the duration of the period between RFA and delivery. Conclusion RFA conducted through the dorsal insertion angle is technically feasible for selective reduction in complex monochorionic multiple pregnancies. Gestational age at this procedure is an independent risk factor for the duration of pregnancy post-RFA.

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Types of Stressors on Nonprofessional Against-Suicide and Pro-Suicide Message Boards

Crisis ◽

10.1027/0227-5910/a000562 ◽

2019 ◽

Vol 40 (4) ◽

pp. 257-264 ◽

Cited By ~ 1

Author(s):

Thomas Niederkrotenthaler ◽

Benedikt Till

Keyword(s):

Content Analysis ◽

Interpersonal Problems ◽

Suicide Method ◽

Presenting Problems ◽

Message Boards ◽

Safe Method ◽

Different Types ◽

Psychiatric Problems

Abstract. Background: Little is known about presenting problems of primary posters (i.e., posters opening the thread) and their responders in nonprofessional against-suicide and pro-suicide message boards. Aims: We aimed to compare problems described in suicide message boards between different types of users (primary posters and respondents) and between against-suicide, neutral, and pro-suicide message boards. Method: In all, 1,182 archival threads with 20,499 individual postings from seven nonprofessional suicide message boards supporting an against-suicide, neutral, or pro-suicide attitude were randomly selected. Problems mentioned by primary posters and their respondents were coded with content analysis. Differences between pro-suicide, neutral, and against suicide boards, as well as correlations between primary posters and respondents, were calculated. Results: Interpersonal problems were most frequently mentioned by primary posters in against-suicide threads (40.9%) and less frequently in pro-suicide threads (11.8%; p < .001). In pro-suicide boards, the most frequent stressors were suicide method-related (e.g., how to identify a safe method: 26.2% vs. 2.5% in against-suicide boards, p < .001). Primary posters resembled respondents in terms of presenting problems in pro-suicide boards, but not in against-suicide boards. Limitations: Only self-reported problems were assessed. Conclusion: The results confirm a stronger focus on death than on life among users in pro-suicide message boards, and posters with similar problems meet in pro-suicide boards. The posters appear to clearly emphasize social strains over psychiatric problems compared with some professional settings.

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