Spontaneous fetal reduction in multiple gestations assessed by transvaginal ultrasound

Objective To assess the occurrence of disappearance of one or more of the fetuses in pregnancies which start as multiple gestation. Design Observational study. Setting Infertility section, Rambam Hospital, Haifa. Subjects 88 women with multiple gestations, established after ovulation induction (54 twin, 26 triplet, five quadruplet, and three quintuplet) and diagnosed by trans‐vaginal ultrasound at 5–6 weeks, in all of whom absorption of at least one gestation sac was detected at follow‐up ultrasound scan. Interventions Follow‐up by serial transvaginal and later abdominal ultrasound scan throughout pregnancy. Results Of the 54 twin gestations, 51 ended in the birth of a singleton and three in miscarriage. Of the 26 pregnancies starting as triplets, 12 ended in singleton births, 12 in twins and two miscarried. The five quadruplet gestations resulted in one singleton birth, one set of twins, two triplets, and one ended in late miscarriage. Of the three quintuplet pregnancies, two resulted in the birth of triplets, one of them after spontaneous, the other after iatrogenic fetal reduction. In the third quintuplet pregnancy, one fetus vanished spontaneously and another was subject to iatrogenic reduction, two fetuses survived and were liveborn. Of the 221 fetuses identified 107 (48%) vanished spontaneously. Conclusion Iatrogenic fetal reduction should be delayed until 12 weeks gestation in quadruplet or higher multiple gestations, but is probably not indicated in twin and triplet gestations.