The traditional Chinese belief is that more children are more blessed, and under the social policy of “only one good child”, many infertility patients hope to have more follicles and more embryos transferred during treatment, so as to help them conceive and deliver more children at one time. However, this is counterproductive. Multiple pregnancies (two or more fetuses in a single pregnancy) are pathological pregnancies and often result in multiple complications during pregnancy and delivery, posing a serious threat to the safety of the mother and child.
As the number of fetuses increases, perinatal mortality increases significantly, and even if multiple preterm infants survive, their physical and intellectual quality may decline. In order to effectively and safely control the number of embryos and deliveries, reduce the damage to the mother and child in multiple pregnancies, and improve the survival rate and quality of surviving children, it is necessary to perform elective reduction of multiple pregnancies.
So let’s first look at the complications of multiple pregnancies with multiple pregnancies.
1, miscarriage: the spontaneous abortion rate of twin pregnancies is 2 to 3 times higher than that of singleton pregnancies. The greater the number of fetuses, the greater the risk of miscarriage, associated with embryonic malformations, abnormal placental development, impaired placental circulation and relative narrowing of the uterine cavity volume.
2, gestational hypertension syndrome: the incidence is three times higher than that of singleton pregnancy, the symptoms appear early and are mostly severe, often not easy to control, and the incidence of eclampsia is also high. Eclampsia is a serious threat to the health of mother and child.
3, anemia: the incidence is 2.4 times higher than that of singleton pregnancies. Due to the increase in blood volume and the need for iron, iron deficiency anemia is common in the second half of pregnancy. If folic acid deficiency can lead to megaloblastic anemia. Anemia leads to fetal hypoxia, which further promotes intrauterine growth retardation.
4, excessive amniotic fluid: the incidence of excessive amniotic fluid in twin pregnancies is 12%, which is associated with twin fetal transfusion syndrome and fetal malformation.
5, placenta abruptio and placenta praevia: placenta abruptio is the main cause of prenatal hemorrhage in twin pregnancies. It starts rapidly, develops quickly, and seriously threatens the health of mother and child. Due to the large area of the placenta, it is easy to extend to the lower part of the uterus and cover the endocervix, forming placenta praevia, the incidence is 1 times higher than that of singleton.
6, intrahepatic cholestasis during pregnancy: 2 times higher than that of singleton. It is easy to cause preterm labor, fetal distress, stillbirth and stillbirth.
7, postpartum hemorrhage and puerperal infection: uterine muscle fiber overstretching causes weak contraction of the uterus, large placental attachment surface, easy to develop postpartum hemorrhage and increase the chance of infection.
What are the effects of multiple births on the fetus? The perinatal mortality rate is significantly higher in multiple births.
1, preterm birth: 50% of the complications of preterm birth. The incidence of preterm labor is high when the number of fetuses is high and the intrauterine pressure is too high when there is too much amniotic fluid. Most preterm births occur naturally or after premature rupture of fetal membranes. According to statistics, the average gestation period of twin pregnancies is only 37 weeks.
The fetal growth retardation in utero is the most common complication of multiple pregnancies. before 30 weeks of gestation, the growth rate of twin fetuses is similar to that of a single fetus, and thereafter it slows down. The incidence is 12%-34%, the degree of which increases with the gestational weeks, and the growth of the two fetuses is not coordinated, and monozygotic twins are more significant than dizygotic twins.
3, intrauterine death of one of the twins: in multiple pregnancies, not only are there more miscarriages and preterm births than in singleton pregnancies, but there are also more intrauterine deaths of the fetus. Sometimes, one of the twins dies in utero and the other fetus continues to grow and develop. Fetal death in late pregnancy can cause diffuse intravascular coagulation. About 30% of coagulation dysfunction occurs in more than 4 weeks of retention.
4, fetal malformations: the rate of fetal malformations in twin pregnancies is 2 times higher than in singleton pregnancies, the reasons for the increased malformation rate are unclear, intrauterine compression can lead to malformed feet, congenital hip dislocation and other fetal local malformations.
This shows that the disadvantages of multiple pregnancies outweigh the advantages. Therefore, fetal reduction is to protect the life rights of mother and child and to ensure the quality of fetal life. The Ministry of Health’s “Technical Specification for Assisted Human Reproduction” has clear regulations on the number of embryos to be transferred, and the chance of multiple pregnancies occurring with assisted conception has greatly exceeded the incidence of multiple pregnancies in natural pregnancies.
Therefore, the Ministry of Health also clearly stipulates that multiple pregnancies must be reduced, avoiding twin pregnancies and strictly prohibiting the delivery of three or more pregnancies.
The technique of reduction is very mature and the survival rate of the remaining fetus after early reduction is very high, and the procedure can be performed mainly by two routes, transvaginal or transabdominal.
The following is a brief description of the early transvaginal reduction.
1. Transvaginal reduction of fetus is adopted for early reduction.
Under the guidance of vaginal ultrasound, a special needle is used to puncture the embryo through the uterine wall and enter the embryo sac where the embryo is to be destroyed, and directly puncture the heart tube of the embryo to reduce the fetus. The needle is usually inserted only once and the pain is mild and most patients report that they can tolerate it, while some patients do not feel it.
2. Late reduction after 12 weeks in the obstetrics department by transabdominal reduction.
The energy consumption and economic cost of fertility treatment for fertility patients are great, and under such premise, it is especially important to have a healthy baby. Many patients take a chance and refuse to reduce the fetus on the grounds that it is risky, thinking that I can afford to raise three babies and that miscarriage and preterm delivery may occur before the fetus matures, and that all the previous fertility treatment is wasted. At that time, it is too late to regret that they did not listen to the doctor’s advice.