Trans-abdominal fetal reduction in higher order multiple pregnancies: a pioneer cohort retrospective study in Nepal

Objective: To share initial experience of transabdominal multifetal pregnancy reduction (MFPR) in Nepal. Method: The procedure was performed in 108 patients in a private hospital over a period of 3 years. Under ultrasound guidance, intracardiac injection of 0.2 to 3.0 ml of 15% w/v (2 mEq/mL) potassium chloride (KCl) was administered via transabdominal route. Results: A total of 108 fetal reduction procedures were carried out at the seventh to fifteenth weeks of gestation, a maximum of 44 (40.7%) of which were done at the ninth to tenth weeks of gestation. A total of 123 fetuses were reduced. Out of total 108 multifetal pregnancies, 96 (88.8%) were due to In Vitro fertilization (IVF). 85 pregnancies (78.7%) underwent reduction from triplet to twin. The second-time reduction was needed in 5 cases. Two attempts (in the same sitting) were required in 3 cases. Inadvertent demise of the second fetus was noted in 3 cases of dichorionic triamniotic triplet pregnancy. Conclusion: Ultrasound-guided transabdominal fetal reduction performed between the seventh and twelfth weeks of gestation is safe and effective.