| Background and objectIn recent years, with the applications of assisted reproductive technology increased, multiple pregnancies showed an increasing trend year by year, which increased the incidence of adverse outcomes of females and children. Selective fetal reduction is mainly used to reduce the number of multiple fetuses and abnormal fetuses, which can significantly improve pregnancy outcomes. Currently, selective fetal reduction based on non-invasive prenatal diagnosis decides which will be the reduced fetus mainly depended on the following fectors, the situations of surgery (including fetal position, placental location, the chorionic character, etc.), the difficulty of operation, and non-invasive prenatal diagnostic techniques such as ultrasound measurements of the nuchal translucency thickness, fetal malformation etc. However, this method is difficult to detect chromosomal abnormalities without significant ultrasound structural abnormalities of fetus, and can not ensure that the presence of non-lethal fetal malformations are the result of chromosome abnormalities. In traditional multifetal pregnancy reduction (MFPR) cases, fetal chromosomal result depends on the second trimester amniocentesis, but at that moment the fetus of chromosomal abnormalities has been retained from fetal reduction, patients will have to face the choice of either producing fetus of chromosomal abnormalities or abortion. So invasive prenatal diagnosis before MFPRis necessary.Invasive prenatal diagnosis before multifetal pregnancy reduction is a invasive diagnostic method which is based on karyotype results and used to guide MFPR. It has been received in foreign countries. Unlike singleton pregnancies, in multiple pregnancies the accurately distinguishing of normal and abnormal fetuses, and the preparement for fetal reduction need complicated, repetitive prenatal diagnosis. In multiple pregnancies there are more applications of repetitive prenatal diagnosis.In this study, we analyze five cases of multiple pregnancies which used invasive prenatal diagnoses before MFPR, and evaluate the choice of surgical approaches in prenatal diagnosis and fetal reduction patients, and the methods of fetal positioning.MethodWe retrospectively analyze five cases of multiple pregnancies which used invasive prenatal diagnoses before MFPR between September,2011to February,2014in Obstetrics and Gynecology department of Shandong Provincial Hospital Affiliated to ShandongUniversity. Patients have ultrasound abnormalities during pregnancy, or have a clear chromosomes and genetic abnormal family history or birth history, but lack of clear fetal chromosome test results or no apparent lethal ultrasound visible deformities. After obtained the informed consent of patients, we carry out invasive prenatal diagnosis, and carry out fetal reduction according to the karyotype analysis or genetic test results. We record and analysis all patients’medical history, diagnostic procedures, prenatal diagnosis and fetal reduction operation process, positioning method and pregnancy outcomes, etc.ResultThe5cases of MPFR after invasive prenatal diagnosis were implemented amniocentesis, fetal umbilical cord puncture or cardiac blood puncture before MPFR. The fetuses expected to be reduced were determined according to fetal chromosomal analysis or genetic test results. The major positioning methods of prenatal diagnosis and fetal reduction were distinguishing the fetus according to the placenta, fetal sex, fetal position and so on. Four patients have been successfully give birth to normal child, one patient is still in pregnancy, but the ultrasound of antenatal care has showen that the reduced fetus is the abnormal one.ConclusionUsing ultrasound-positioning the fetus according to the fetus itself, placenta features in this experiment is reliable. But this experiment lack of large sample randomized controlled study, we still can not come to the conclusion that the approach is safe and effective. |
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