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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (5): 943-947. doi: 10.19723/j.issn.1671-167X.2022.05.022

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Clinical effect of fetal reduction by intracranial and intrathoracic KCl injection

Hong-xia ZHANG,Rui YANG,Shuo YANG,Ning-ning PAN,Lin-lin WANG,Rong LI*()   

  1. Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-04-07 Online:2022-10-18 Published:2022-10-14
  • Contact: Rong LI E-mail:roseli001@sina.com
  • Supported by:
    Beijing Science and Technology Planning Project(Z191100006619085)

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Abstract:

Objective: To evaluate the feasibility and effectiveness of fetal reduction by transabdominal intracranial KCl injection for multifetal pregnancies in the early second trimester. Methods: The data of 363 patients who underwent transabdominal fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2019 were analyzed retrospectively. According to the location of fetal reduction, they were divided into two groups: Intracranial injection group (n=196) and intrathoracic injection group (n=167). The process of fetal reduction and pregnancy outcome of the two groups were compared. Results: There was no significant difference between the two groups in the average age and the proportion of type of infertility before assisted reproductive technology, conception method, indication for fetal reduction, starting number of fetuses, reduced number of fetuses, and finishing number of fetuses (P>0.05). There was no significant difference between the two groups in the proportion of the number of puncture ≥ 2 times (12.1% vs. 8.6%, P=0.249) and the incidence of replacing puncture site (10.7% vs. 6.4%, P=0.161). The next day after fetal reduction, color Doppler ultrasound was rechecked. In the intracranial injection group and intrathoracic injection group, the incidence of fetal heartbeat recovery [3.6% (8/224) vs. 1.1% (2/187), P=0.188], the volumes of KCl used [(2.6±1.0) mL vs. (2.8±1.1) mL, P=0.079], and the abortion rate within 4 weeks after fetal reduction (1.0% vs. 0.6%, P=0.654) were of no significant difference. In addition, there was no significant difference in the total abortion rate after fetal reduction, premature delivery rate, cesarean section rate, delivery gestational week and neonatal birth weight between the two groups (P>0.05). Conclusion: Intracranial KCl injection can be an effective alternative to intrathoracic KCl injection for multifetal pregancy reduction.

Key words: Multiple pregnancy, Selective fetal reduction, Intracranial puncture, Intrathoracic puncture

CLC Number: 

  • R714.23

Table 1

Characteristics of patients undergoing transabdominal fetal reduction"

Characteristics Intracranial injection (n=196) Intrathoracic injection (n=167) t/χ2 P
Age/years, ${\bar x}$±s 32.1±4.3 32.5±4.6 -0.976 0.330
Type of infertility before ART, n(%) 0.959 0.327
  Primary infertility 92 (46.9) 87 (52.1)
  Secondary infertility 104 (53.1) 80 (47.9)
Conception method, n(%) 2.866 0.239
  IVF-ET/FET 131 (66.8) 122 (73.0)
  IUI 49 (25.0) 28 (16.8)
  Ovulation stimulation 16 (8.2) 17 (10.2)
Indication for fetal reduction, n(%) 2.603 0.272
  Fetal malformation 17 (8.7) 21 (12.6)
  Maternal factors 74 (37.8) 69 (41.3)
  Multiple pregnancy 105 (53.5) 77 (46.1)
Time of fetal reduction (weeks of gestation), n(%) 0.460 0.795
  12 weeks 121 (61.7) 105 (62.9)
  13 weeks 58 (29.6) 45 (26.9)
  14 weeks 17 (8.7) 17 (10.2)
Starting number of fetuses, n(%) 0.360 0.835
  2 144 (73.5) 118 (70.7)
  ≥3 52 (26.5) 49 (29.3)
Reduced number of fetuses, n(%) 0.42 0.52
  1 168 (85.7) 147 (88.0)
  2 28 (14.3) 20 (12.0)
Finishing number of fetuses, n(%) 1.922 0.166
  Singleton 169 (86.2) 135 (80.8)
  Twins 27 (13.8) 32 (19.2)

Table 2

Comparison of transabdominal fetal reduction procedures by intracranial and intrathoracic KCl injection"

Items Intracranial injection Intrathoracic injection t/χ2 P
Total reduced number of fetuses, n 224 187
Number of puncture ≥2, n(%) 27 (12.1) 16 (8.6) 1.331 0.249
Change puncture site, n(%) 24 (10.7) 12 (6.4) 2.355 0.161
Fetal reduction again after fetal reduction failure, n(%) 8 (3.6) 2 (1.1) 1.737 0.188
Volume of KCl/mL, ${\bar x}$±s 2.6±1.0 2.8±1.1 -1.763 0.079

Table 3

Comparison of clinical outcomes after transabdominal fetal reduction by intracranial and intrathoracic KCl injection"

Outcomes Intracranial injection Intrathoracic injection t/χ2 P
Total abortion rate 11.7% (23/196) 6.6% (11/167) 2.815 0.093
Abortion rate within 4 weeks after fetal reduction 1.0% (2/196) 0.6% (1/167) 0.201 0.654
Preterm birth rate 15.0% (26/173) 23.7% (37/156) 2.784 0.095
Cesarean section rate 76.9% (133/173) 76.3% (119/156) 0.001 0.982
Singleton delivery (weeks of gestation), ${\bar x}$±s 37.9±2.4(n=148) 37.8±2.3(n=128) 0.227 0.821
Singleton newborn weight/g, ${\bar x}$±s 3 078.4±582.4(n=148) 3 011.8±559.4(n=128) 0.965 0.335
Twin delivery (weeks of gestation), ${\bar x}$±s 36.5±1.9(n=24) 35.8±2.4(n=25) 1.133 0.263
Twin newborn weight/g, ${\bar x}$±s 2 410.0±517.6(n=48) 2 409.2±504.5(n=50) 0.608 0.545
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