Intracranial Injection With KCL: An Alternative Method Of Multifetal Pregnancy Reduction

OBJECTIVE:The study of multifetal pregnancy reduction with intracranial injection with KCL was undertaken to investigate the safety, effectiveness, time of the operation, selection of the reduced fetuses, optimal number of remained fetuses and other issues faced in clinical experience of this special method of fetal reduction. So we can make sure if it can be used as an auxiliary way of multifetal pregnancy reduction.METHODS:We conducted a comparative study that comprised 8 pregnant women with 3 or 4 fetuses at the gestational weeks between 11+3 and 19+2 weeks that accepted MFPR with intracranial injection with KCL in the obstetric department of Shandong Provincial Hospital between June 2009 and December 2009.RESULTS:1. Of all the 8 cases,8 cases(100%) were complete.6 cases(75%) were with 3 fetuses,2 cases (25%) were with 4 fetuses.7 cases (87.5%) request to reduce the number of fetus,1 case (12.5%) request to reduce the fetus with malformation.2 cases (25%) were with small fetus,2 cases (25%) were with small fetus and frequent fetal movement,1 cases (12.5%) was with fetal location factors,3 cases (37.5%) were with fetal location factors and frequent fetal movement.5 cases (62.5%) were performed with MFPR with intracranial injection with KCL alone,3 cases (37.5%) were performed with a combination MFPR with intracranial and intracardial injection with KCL.7 cases (87.5%) were reduced to twins,1 case (12.5%) was reduced to singleton.1 case (12.5%) was detected to have heart rebeating under ultrasound within 24 hours, so we give her a second MFPR with intracardial injection with KCL. Of all the 8 cases with 26 fetuses, we performed 9 MFPR,reduced 9 fetuses,2 fetuses were also killed because they were monochorionic twins. The average time of reduction was 15 to 30 minutes.2. The postoperative follow-up:Of all 8 cases,5 cases (62.5%) had a term delivery,1 case is still in pregnancy,2 cases had miscarriage.CONCLUSIONS:1. Multifetal pregnancy reduction with intracranial injection with KCL is a well-targeted, secure, reliable effective and minimally invasive method. When the fetal hearts are hard to reach because of the small fetus, frequent fetal movement or fetal location factors, it can be an alternative or auxiliary way of MFPR. It can reduce fetal numbers, in order to effectively improve the outcome of pregnancy, length gestational age, reduce pregnancy complications, improve the successful pregnancy rate, increase birth weight, improve birth quality, and avoid the appearance of fetal malformation and fetal chromosomal abnormalities at birth.2. Multifetal pregnancy reduction with intracranial injection with KCL is an effective reduction method. KCL was absorbed by the fetus through the circle of Willis and the branch of middle cerebral artery, it can cause cardiac asystole in a short time.3. As the fetal cardiac asystole caused by intracranial injection of KCL is slower than that by cardiac injection, we need more time to observe the cardiac asystole after the intracranial injection of KCL, especially for the monochorial twins. 4. Even the fetal heart does not disappear after the injection of KCL, it also can decrease the fetal movement or make it disappear because of the damage of fetal brain tissue, to create the conditions for the cardiac injection.