Journal of Ultrasound in Medicine, Vol 17, Issue 7 447-449, Copyright © 1998 by American Institute of Ultrasound in Medicine
Multifetal pregnancy reduction of both fetuses of a monochorionic pair by intrathoracic potassium chloride injection of one fetus
C. B. Benson, P. M. Doubilet, D. Acker and L. J. Heffner
Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
The purpose of this study was to determine if a monochorionic pair of
fetuses in a higher-order multiple gestation can be reduced by injecting
only one fetus with potassium chloride. Three quadruplet and two quintuplet
gestations, each with a monochorionic pair of fetuses, were referred for
pregnancy reduction. In each case, reduction was performed by injecting one
of the monochorionic pair with potassium chloride. Patients returned for a
follow-up sonogram within 1 week of the procedure. The reductions were
performed at an average 12.1 weeks' gestation, with a range of 10.7 to 14.0
weeks. Follow-up scans 4 to 7 days after the procedure showed that both
monochorionic fetuses were dead and all other fetuses were alive. One
quintuplet pregnancy underwent a second reduction procedure to twins. One
quintuplet and two quadruplet pregnancies that were reduced to twins
resulted in the birth of live twins between 30.8 weeks and 36.8 weeks'
gestations. The third quadruplet pregnancy reduced to twins is still
ongoing; the mother is pregnant with twins at 20 weeks' gestation. The
quintuplet pregnancy reduced to triplets resulted in delivery of live
triplets at 24.1 weeks' gestation, but two of the neonates died in the
first few days of life. Reduction of both fetuses of a monochorionic pair
in a higher-order multiple gestation can be accomplished by intrathoracic
injection of potassium chloride into only one of the pair.
