Selective termination of abnormal fetus safe. (Series of 200 Multifetal Gestations).

NEW ORLEANS -- Selective termination of an abnormal fetus in a multifetal gestation continues to be associated with a low overall unintended pregnancy loss rate, Dr. Keith A. Eddleman said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a series of 200 procedures performed at Mount Sinai School of Medicine in New York--the largest single-center experience with this procedure in the world--the spontaneous loss rate stood at 4%.

"There were eight unintended pregnancy losses in our series," Dr. Eddleman said. "Four of the losses were in twins, giving a loss rate in that group of 2.4%, and four were in triplets, for a loss rate of 12.5% in that group," he said.

A total of 82% of cases involved twins, while 16% involved triplets and 2% involved quadruplets. Even though the triplets represented only 16% of the study population, they represented half of the pregnancy losses, he said.

The overall loss rate among all patients presenting with pregnancies of a higher order than twins was 11.1%, which reflected a statistically significant difference from the 2.4% loss rate with twins only. "In our previous report of 100 cases, the spontaneous loss rate after the procedure was 3%," said Dr. Eddleman of Mount Sinai.

But a subsequent international collaborative series that included 402 cases from four countries found higher loss rates of 7% when the final number of fetuses was one and 13% when the final number was two (Am. J. Obstet. Gynecol. 181[4]:893-97, 1999).

"Therefore, because of the differences in these data we decided to do an expanded series," he said at the meeting, which was cosponsored by the American College of Obstetricians and Gynecologists.