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Human Reproduction, Vol. 10, No. 4, pp. 818-825, 1995
© 1995 European Society of Human Reproduction and Embryology

research-article

Genetics: Genetic analysis prior to selective fetal reduction in multiple pregnancy: technical aspects and clinical outcome

B. Brambati1, L. Tului2, M. Baldi3 and S. Guercilena4

1First Institute of Obstetrics and Gynecology, University of Milan Milan 2Reproductive Medicine Centre Milan 3Human Genetics Centre Rome 4Institute of Occupational Health, Epidemiology Unit, Istituti Clinici di Perfezionamento Milan, Italy

Correspondence: 1To whom correspondence should be addressed at: Via Commenda 12, 20122 Milan, Italy

Multiple pregnancies resulting from ovarian stimulation are at a higher risk of carrying at least one fetus affected by Mendelian or chromosomal anomalies, the incidence of which is directly related to the order of multiples. Genetic analysis before fetal reduction was offered to both high-and low-risk pregnant women carrying two or more fetuses after ovulation induction. Chorionic villus sampling (CVS) and fetal reduction were achieved by transabdominal needling. The use of short-term culture, the polymerase chain reaction and fresh tissue enzymatic analyses have made it possible for genetic diagnosis to be available in a few days. A total of 100 patients had multifetal pregnancy reduction performed by a single operator; all of them completed pregnancy and none was lost at follow-up. The total fetal loss before 24 weeks was 7% and no statistically significant relationship was found with the final number of fetuses and CVS. Perinatal losses (3.9%) were only present in the series with a final number of two fetuses. Pregnancy duration and birthweight were significantly higher in singletons than in twins, but were not related to CVS. The rate of chromosomal disorders was higher (7.2%) in the study series than in singleton pregnancies not undergoing fetal reduction. Diagnostic error due to incorrect sampling was reported in 1.5% of cases. These data support fetal reduction as a valuable strategy to improve the outcome of multiple pregnancy. The outcome of pregnancies reduced to singletons was significantly better than of those reduced to twins, and was not related to CVS. Therefore, prenatal genetic diagnosis should become an integral part of counselling on multiple pregnancy, and is strongly recommended when reduction to singleton pregnancy is requested.

Key words: genetic diagnosis/multiple pregnancy/reduction/singletons/twins


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This article has been cited by other articles:


Home page
 Reproductive SciencesHome page
J. L. Simpson and S. A. Carson
Multifetal Reduction in High-Order Gestations: A Nonelective Procedure?
Reproductive Sciences, January 1, 1996; 3(1): 1 - 2.
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