Why Should Embryo Reduction be Performed?
Embryo reduction is a procedure in which the number of embryos is reduced to two if there are three or more embryos. This is an attempt to avoid the risks associated with multiple pregnancies. The main complication of three or more multiple pregnancies is premature birth. This procedure attempts to extend the birth week to the 35-36th week of pregnancy. This reduces the need for neonatal intensive care for babies born at a more appropriate week, and also attempts to reduce potential brain damage (cerebral palsy). For example, 25% of triplets are born before 32 weeks of gestation and 8% are born before 28 weeks of gestation; accordingly, the birth weight of triplets is ten times more likely to be less than 1000 grams compared to normal single births and the general population. When there are four or more fetuses, these rates are much higher. In addition, problems such as preeclampsia (gestational hypertension), diabetes, and postnatal hemorrhage are also more common in expectant woman.
How Is Embryo Reduction Performed?
This procedure is preferably performed between 10 and 13 weeks of pregnancy. If no abnormal fetus is detected during ultrasound examination, the technically suitable fetuses are selected. In case of monochorionic twins (identical twins), the procedure is performed on them.
After the needle insertion site is cleaned under sterile conditions and ultrasound monitoring, the needle is inserted into the gestational sac through the abdominal wall and uterus of the expectant mother, and the hearts of the baby or babies in the amniotic sac are stopped by administering KCl. Depending on the number of babies, more than one needle may be required.
What can happen after embryo reduction?
The rate of miscarriage after embryo reduction is about 5%. A miscarriage can be caused by the needle puncturing the uterine wall and membranes during the procedure, or it can be caused by dead tissue left inside. Miscarriage occurs after the amniotic sac opens, bleeding or infection. The development of a hematoma (blood clot) on the mother's abdominal wall is rare and usually resolves spontaneously.