Réduction embryonnaire: indications, techniques, impact psychologique

• Published in: La Presse médicale (1983) 2008-02, Vol.37 (2), p.295-306
• Main Authors: Sentilhes, Loïc, Audibert, François, Dommergues, Marc, Descamps, Philippe, Frydman, René, Mahieu-Caputo, Dominique
• Format: Article
• Language: fre
• Subjects: Generalites; Sciences biologiques et medicales; Sciences medicales
• ISSN: 0755-4982; 2213-0276
• DOI: 10.1016/j.lpm.2007.05.016

High-order multiple pregnancies (triplets and above) are associated with high pediatric mortality and morbidity, mainly due to their premature delivery. Maternal morbidity is also substantially higher than for singleton gestations. The main goal of multifetal pregnancy reduction (MFPR) is to decrease the rate of severe prematurity and its consequences, including neurodevelopmental handicaps. It may also reduce the risk of maternal complications. Transabdominal needle-guided procedures, performed at 10-12 weeks, are the most common technique for MFPR. Transvaginal needle aspiration can be used successfully earlier in gestation (7-8 weeks). Transcervical aspiration is no longer used. There is generally no medical indication for MFPR in twins. MFPR does not reduce the risk of loss of the entire pregnancy before 24 weeks and may increase the risk of a second-trimester miscarriage by 1-2%. MFPR substantially decreases premature delivery rates, cutting the risk of delivery at 29-32 menstrual weeks in triplet pregnancies in half for reductions to twins and by five for reduction to singletons. The positive effect of MFPR on perinatal outcome is incontrovertible for quadruplets and higher-order pregnancies. Advances in perinatal medicine have substantially reduced mortality in premature triplet deliveries, however, and this should be taken into account when considering the potential benefit of MFPR. MFPR is a distressing experience for parents, but seems not to have long-term adverse effects on women’s psychological well-being. Maternal distress related to MFPR tends to fade with time. The negative psychological impact of MFPR should be weighed against that related to raising the children from high-order pregnancies. Prevention of high-order multifetal pregnancies is essential and requires careful monitoring of infertility therapies. Les grossesses multiples de haut rang, triples et au-delà, sont associées à un taux élevé de mortalité et de morbidité pédiatrique principalement expliqué par la prématurité, et à un risque accru de complications maternelles. L’objectif principal de la réduction embryonnaire est de limiter le risque de grande prématurité des grossesses multiples de haut rang et ses conséquences. Trois techniques sont possibles: la voie transcervicale n’est plus utilisée, la voie transvaginale est réalisée vers 8 semaines d’aménorrhée (SA), et la voie transabdominale, la plus courante, vers 10-12 SA. En cas de grossesse gémellaire, la réduction embryonn