At present, very often a multiple pregnancy is the result of infertility treatment with harmony products that stimulate ovulation. This also includes the IVF procedure. Very often, with the conception of three or even two babies, pregnancy becomes dangerous. On this basis, in order to reduce the likelihood of complications of pregnancy, as well as its improvement, the doctor may suggest reduction of embryos to the expectant mother.
Reduction in multiple pregnancy
Reduction is a procedure that is designed to remove and kill several embryos from the uterine cavity. It must be carried out when a very serious danger to the health of the mother, as well as to another fetus, warns. After this procedure, the embryonic tissues remain in the uterus, and then after a while they resolve on their own.
The reduction was first used thirty years ago, when very serious pathologies were detected in the embryos. This is possible only for women who bear more than one child and at the same time save the life of other babies. By the end of the eighties in the last century, reduction was used to remove non-viable embryos when in vitro fertilization occurred. It was necessary to reduce the risks of various complications.
There are several types of such risks:
- preterm birth;
- spontaneous abortion;
- death of all embryos;
- pathological development of the embryo;
- mortality during childbirth of the second and subsequent baby.
Embryo Reduction Conditions
Embryo reduction is the most serious procedure that is carried out if there is evidence:
- three or more embryos are implanted in the uterus;
- a very serious pathology is detected in the fetus;
- with very poor health of the mother, who can not bear several children.
The procedure must be performed using the following conditions:
- medical personnel must comply with special qualifications, and the hospital itself must have special equipment;
- people should not have the disease: HIV, hepatitis C, B, syphilis should be absent, and blood, urine and smear tests should also be good;
- Patients must sign the consent in the established correct form, which is intended for the reduction.
Embryo reduction exercise
With multiple pregnancy, fetal reduction is carried out, as a rule, for periods of five to thirteen weeks of pregnancy. The most suitable period for such a procedure is 8 weeks of pregnancy. It is at such a period that reduction is necessary, since at the very early stages some embryos can stop their development and also disappear on their own. With this option, no medical intervention will be needed.
In the later stages, fetal reduction can also be done, but not always, since the bones of the fetus in the uterus will dissolve for a very long time. This will lead to spontaneous abortion by pregnancy, as well as to an increase in the tone of her muscles.
There are several criteria for removing embryos:
- the presence of embryos of pathological development;
- the smallest indicator of parietal-coccygeal size;
- sizes of pathological collar space;
- there is convenient access to the embryo, which excludes contact with other embryos that are not subject to reduction.
The doctor determines the condition of the embryos that remain in the uterus. The doctor also takes into account all the features of implantation, determines the size of the chorion, the structure of the fetal eggs and the presence of yolk sacs.
Methods of fetal reduction
Reduction of the fetus can be carried out by the transcervical method, which occurs through the cervical canal itself.
This process occurs at the earliest possible date and also involves the introduction of a special catheter into the cervical canal, which is connected to a vacuum aspirator. It is brought to the fetal egg, and the embryo itself is destroyed only under the constant supervision of an ultrasound scan. This procedure is done without anesthesia.
This method has various disadvantages:
- during surgery, every cervical injury can go into a miscarriage;
- You can remove the embryo if it is located at the very exit of the ovum;
- through the cervical canal, the microflora of the vagina enters the uterus;
- during the reduction procedure, you can damage the ovum, which is next to it.
Based on all these shortcomings, at present, the reduction of the fetus by the Transcervical method is very rare.
It is done through the vagina for a period of seven weeks under general anesthesia, as well as under an ultrasound test probe using a biopsy needle. First, a puncture is made in the very wall of the uterus, and then they begin to enter the embryo into the chest. To completely stop the cardiac activity of the embryo, an injection of a solution of potassium chloride is carried out.
The main advantages of this method: a small risk of injuries for the embryos that are nearby, as well as its use at an early date. It is especially dangerous if the calculated dose of the right drug is not correctly administered, as this can be harmful to another embryo.
This method is very similar to Transvaginal. The difference is the place of introduction of the needle, as well as the timing itself. With the transabdominal method, the needle is inserted through the abdominal wall in front, as well as at eight weeks of pregnancy. This method is carried out with local anesthesia and with constant monitoring of ultrasound. The transabdominal method has the lowest risk of infection of the uterine cavity, and is also the most convenient for choosing any embryo for reduction. Currently, this is the most common method.
Each method has its own disadvantages and advantages. And each of them can affect a further complication during pregnancy.
Complications of the procedure
The very threat of spontaneous abortion after reduction, which has already been carried out, occurs in every second woman, and, as a rule, ends in a miscarriage.
After the surgical period, death of the lagged embryos can occur, an inflammatory process can occur in the uterus itself, and the tone of the muscles of the uterus increases. If the reduction of the fetus is unsuccessful, then the embryo that has been damaged continues to develop.