Selective embryo-fetal reduction
•Download as PPTX, PDF•
6 likes•945 views
Oral communication in the Fetal Medicine Foundation World Congress, june 2013. Description of the results in our hospital after 20 years of selective embryo-fetal reduction. Factors affecting outcome.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Selective embryo-fetal reduction
Similar to Selective embryo-fetal reduction (20)
Recently uploaded
Recently uploaded (20)
Selective embryo-fetal reduction
- 1. The Fetal Medicine Foundation Sofía Fournier Margarita Torrents Cayetana Barbed Mónica Echevarría Mina Comas MARBELLA, JUNE 2013 SELECTIVE EMBRYO-FETAL REDUCTION. OUR EXPERIENCE OVER THE LAST 20 YEARS FACTORS AFFECTING OUTCOME HOSPITAL UNIVERSITARIO QUIRÓN DEXEUS, BARCELONA. SPAIN 0% 10% 20% 30% 40% 50% 60% <37 weeks < 34 weeks < 32 weeks congenital defect multiple pregnancy N: 177 From 1989 to 2011
- 2. The Fetal Medicine Foundation Selective embryo-fetal reduction. Factors affecting outcome Objective: To analyze our own results in selective embryo-fetal reductions during a 22-year period, focusing on percentage of fetal loss and prematurity rate Material and methods: 177 embryo-fetal reductions performed from 1989 to 2011 149 cases with a complete follow-up (84,2%) Indications: 64,9% multiple pregnancy 35,02% congenital defect Only one operator performing all the cases Introduction: Indications for a selective embryo-fetal reduction in our hospital: -High order multiple pregnancies (>3) or triplets in high-risk patients -Congenital defect in one of the embryos/fetuses
- 3. The Fetal Medicine Foundation Results: Fetal loss according to: Selective embryo-fetal reduction. Factors affecting outcome P: 0,59 P: 0,77 P: 0,23 No significant relationship with GA. Higher risk <10th week: linked to cases performed during the initial period (higher number of embryos to reduce and less experience). Trend higher risk >12th week No significant relationship with the initial number of fetuses (trend to increased risk when > 3 fetuses) No significant relationship with the number of fetuses reduced (trend to increased risk when >1 fetus) GA procedure Initial n fetuses n fetuses reduced
- 4. The Fetal Medicine Foundation Results: Selective embryo-fetal reduction. Factors affecting outcome INDICATION OVERALL CONGENITAL DEFECT MULTIPLE PREGNANCY NOT COMPLETE INFORMATION 13 21% 15 13% 28 15,8% FETAL LOSS 5 8,1% 12 10,4% 17 9,6% < 37 WEEKS 9 14,5% 49 42,6% 58 32,8% >37 WEEKS 35 56,5% 39 33,9% 74 41,8% OVERALL 62 35,02% 115 64,9% 177 100% Overall fetal loss rate: 9,6% 8,1% when congenital defect 10,4% when multiple pregnancy Overall prematurity rate: 32,8% 14,5% in the congenital defect group 42,6% in the multiple pregnancy group P < 0,05 0% 10% 20% 30% 40% 50% 60% multiple pregnancy congenital defect P>0,05 Learning curve % fetal loss
- 5. The Fetal Medicine Foundation Conclusions Thank you Selective embryo-fetal reduction. Factors affecting outcome 11% Indication for selective embryo-fetal reduction has significantly changed: Multiple pregnancies in high-risk patients used to be the most frequent Congenital defects is the most frequent indication nowadays The overall perinatal result is worse in cases due to multiple pregnancy, with a higher rate of fetal loss and prematurity. No significant relationship with GA, initial number of fetuses nor number of fetuses reduced Trend to increased risk when >12 weeks (importance of earlier diagnosis) Trend to increased risk when >3 initial fetuses Trend to increase when >1 fetus reduced Performing the technique by expert hands with an appropriate learning curve guarantees better perinatal results.
Editor's Notes
- Hello, my name is Sofia Fournier. I come from Barcelona and I’m going to talk about our series in selecive embryo-fetal reductions. We have been performing this technique since 1989, and I will focus on the factor affecting pregnancy outcome. In our hospital the indications for practising this technique are: when we have a high order multiple pregnancy, which was something quite frequent in the beggining due to initial reproductive assisted techniques, in cases of triplets in high risk patients or in twins with a congenital defect in one of the embryos or fetuses. Usually in the firs case the reduction is performed before than in the case of a congenital defect in one of the twins. The aim of our study is to analyze our own results during a 22 year period, focusing on percentage of fetal loss and prematurity rate. We have performed 177 embryo-fetal reductions in our feto-maternal unit, from 1989 to 2011. We have a complete follow up of 149 cases. And depending on the indication, we have 65% of cases due to multiple pregnancy and 35% due to congenital defect. Only one operator performed all the techniques.
- We have a long serie of cases, not only for the number of cases but as well for the long period of time, and that’s been a factor affecting on our possibilities of collecting all the information. Nevertheless we have been able to find out some factors affecting the outcome: the gestational age in which we perform the technique, the initial number of fetuses and the number of fetuses reduced. We did not find a significant relationship with any of those factors, but if we analyze the results in function of the gestational age wue can see that the higher risk in performing the reduction before the 10th week is linked to those cases performed during the initial period, when there were more embryos to reduce and less experience. And excluding that fact we can see a trend in having more risk when performing it after the 12th week. In the case of the initial number of fetuses, we also can see an increase of risk when it is more than 3 embryos. And finally if we take into account the number of fetus reduced, we also see a trend to an increased risk when we reduce more than one fetus.
- When we analyze the results depending on the main indication we can see that the fetal loss rate is very similar in both groups but not the overall prematurity rate, which is significantly higher in the multiple pregnancy group, as expected. The numbers of overall prematurity are in the case of multiple pregnancy very similar to our multiple pregnancies that haven’t undergone a reduction, but when we take a look at prematurity before 34 or 32 weeks is quite higher in the reduced group that in normal twin pregnancies (15% and 7% in reduced pregnancies and 6% and 5% in the normal ones). If we compare the pregnancies that have undergone a reduction of a fetus with a congenital defect and then continue to be singletone pregnancies, the rate of prematurity is higher than our rate of prematurity in singletons, that is around 5%. And finally, taking advantage of the fact that all the reductions in our hospital have been performed mainly by one operator we have analyzed the effect that the learning curve can have in the outcome. Although the results have no statistical significance, we have found a reduction in the percentage of fetal loss from the beggining till nowadays.
- And just to conclude, i would like to say that the indication for selective embryofetal reduction in our hospital has clearly changed with the years, being multiple pregnancies the main reason in the beggining and congenital defects in twin pregnancies the most frequent indication nowadays. The overall perinatal result is worse in cases due to multiple pregnancy, as expected, with a higher rate of fetal loss and prematurity. That even if there is no significant relationship with the gestational age in which performing the technique, the initial number of fetuses nor the number of fetuses reduced, we have found a trend to increased risk if performing the technique after the 12th week of pregnancy ( so that’s why first trimestre diagnosis), if the initial number of fetuses is higher than 3 or if we have to reduce more than one fetus. Finally, we can conclude that performing those reductions by expert hands with a good learning curve, the final results will be better. Thank you very much.