Pregnancy Outcomes After Higher‐Order Multifetal Pregnancy Reduction: A Retrospective Study

Objective: To investigate the pregnancy outcomes after transvaginal or transabdominal fetal reduction for higher‐order multifetal pregnancies with four or more fetuses. Methods: This retrospective study included 102 patients with higher‐order multifetal pregnancies after ovulation induction. The patients underwent fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2000 to December 2020. Methods of fetal reduction included transvaginal and transabdominal reduction. Pregnancy outcomes of different methods were assessed, including the live birth rate, miscarriage rate, preterm labor rate, and low birthweight rate. Results: Among these 102 patients, 84 (82.4%) underwent transvaginal fetal reduction in early pregnancy, and 18 (17.6%) underwent transabdominal reduction in the second trimester. The live birth rate (66% vs. 78%, p = 0.311), preterm labor rate (24% vs. 33%, p = 0.587), and miscarriage rate (25% vs. 17%, p = 0.653) were comparable for transvaginal and transabdominal fetal reduction. Age, the method of fetal reduction, and the initial number and retained number of fetuses were not influencing factors of the live birth rate or miscarriage rate in these patients. Conclusion: Prevention is the most important measure to decrease the incidence of multiple pregnancies. For higher‐order multifetal pregnancies, multifetal pregnancy reduction (MFPR) is considered a significant remedial measure. Transvaginal fetal reduction in the first trimester of pregnancy and transabdominal fetal reduction in the second trimester were both safe and effective.