Spontaneous Foetal Reduction In Multiple Pregnancies Complicating Fertility Treatment: Descriptive Study Of Pregnancy And Fetal Outcomes In A Low Resourse Setting

Abstract

Objective: Spontaneous reduction resulting from missed abortion of one or more of the foetuses before the 12 week of pregnancy could affect obstetrics outcome. This study sought to analyse pregnancy and foetal outcome following vanishing foetal event in multifoetal pregnancies conceived through assisted and non-assisted technology fertility treatment.Methods: A 5 year prospective observational study conducted In Ahmadu Bello University Teaching Hospital Zaria, 345 Aero medical Hospital Kaduna and Alba Clinics and Medical Centre Kaduna. Patients either conceived with clomiphene citrate enhanced fertility treatment or through assisted reproductive technology (ART) treatment. Results: Fifteen cases were managed, of which 9 (60%) were non-ART conceptions and 6 (40%) ART conceptions. The 9 non – ART pregnancies were all twins spontaneously reduced to singletons, while the 6 ART pregnancies comprised of 4 (66.7%) twins reduced to singleton. 1 (16.7%) triplet reduced to twin and 1 quintuplet (16.7%) reduced to quadruplet. Outcome of 13 pregnancies reduced to singleton was favourable with 1 (7.7%) infant death due to complications of congenital heart disease. Triplet pregnancy reduced to twin was complicated with severe hypertension in pregnancy and spontaneous abortion at 19 weeks while the patient with quintuplet pregnancy reduced to quadruplet delivered at 7 months preceded by preterm premature rupture of membrane; 3 neonatal deaths was recorded. Conclusion: Outcome of vanishing foetus syndrome in higher order multiple pregnancy was associated with poor foetal outcome, however this may be unrelated to spontaneous foetal reduction event but to effect of multiple foetuses on pregnancy and inadequacies of intensive care units in the developing world.