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A selective abortion can be done if a woman has a twin or triplet pregnancy in which one fetus has a chromosome abnormality and the others do not. In a study of 200 selective abortions, the miscarriage rate was only 4%. The risk of a miscarriage was about five times higher in women pregnant with three or more fetuses compared to those with twins.

Multifetal pregnancy reduction will cause a miscarriage in about 5% of all pregnant women who have the procedure, according to a study of 1,000 women who had the operation. This operation is done to reduce the number of fetuses in pregnancies with two or more fetuses. The rate of miscarriage is highest in women with 6 or more fetuses.

Far fewer women today die from a potentially catastrophic obstetric hemorrhage, thanks to prompt blood transfusions and surgical intervention. But what precautions can help patients like Jehovah's Witnesses, whose religious [...]

Chorionic villus sampling appears to be safe when done before a multiple pregnancy is reduced. Chorionic villus sampling is done to determine if any of the fetuses has a genetic disorder. If so, that fetus would be aborted, leaving the healthy fetuses to continue to term.

It appears possible to abort one fetus in a twin pregnancy without harming the remaining fetus, according to an international study of 402 such cases. Most often this is done because one of the fetuses has a severe birth defect and is not expected to live.

Women who had first-trimester multifetal pregnancy reduction generally found it psychologically stressful but recovered. A smaller subgroup tended to experience long-lasting feelings of sadness and guilt. Ninety-one women who underwent multifetal reduction after conceiving triplets to nonituplets via in vitro fertilization agreed to a telephone interview one to three years after the procedure. More than 65% found the procedure emotionally painful, stressful, and frightening. Seventy percent of the women mourned the lost fetuses, but few mourned longer than one month. Moderately severe feelings of sadness or guilt persisted for 20% of the group, especially among younger, more religious women, who had viewed the embryos more frequently on ultrasound. However, 93% would make the same decision again. It is thought that relief and bonding to the remaining fetuses served to buffer negative feelings. Additional psychological support may be of benefit, especially among women fitting the profile of the subgroup that was more likely to experience prolonged or severe reaction.

Fetuses with blood clotting disorders are at increased risk from bleeding to death from cordocentesis. Cordocentesis is a procedure where a blood sample is taken from the fetal umbilical cord by passing a needle through the mother's abdomen. Five fetuses with alloimmune thrombocytopenia, a disease in which the mother's immune system attacks fetal platelets, a blood component responsible for clotting, bled to death after cordocentesis. They were compared with 44 fetuses with the same disease who survived the procedure. The mean platelet count among fetuses who died was 6 versus 33 X 10 to the ninth power per liter among surviving fetuses. Fetuses who died were also more likely to have a sibling with the disease from a prior pregnancy who had a brain hemorrhage before birth. It is strongly recommended that fetuses with platelet counts of 50 or less at the time of cordocentesis receive a blood transfusion before withdrawing the sampling needle.

Fetal endothelin levels exceed those of the mother, but there is no correlation with gestational age. Endothelin is produced by the cells lining blood vessels, and its secretion primarily causes blood vessel constriction. Sixty-four women had blood samples drawn from the umbilical cord by passing a needle through the maternal abdomen. This was done for diagnostic purposes, but all fetuses selected for the study were normal. Prior to the procedure blood was also drawn from the mother. In addition, blood was drawn from the umbilical cord of eight healthy newborns. No correlation was found between either fetal and maternal endothelin levels and gestational age or between endothelin levels between the mother and the fetus. Fetal endothelin levels averaged 2.5 picograms per milliliter versus maternal levels of 1.3 picograms per milliliter versus newborn levels of 15.77 picograms per milliliter. The increase in endothelin level after birth seems reasonable considering the changes in vascular resistance that follow birth.

Increased levels of interleukin-6 (IL-6) in cervical secretions may be associated with preterm birth. IL-6 is produced during inflammatory processes. Vaginal and cervical secretion samples were collected from 161 pregnant women at 3- to 4-week intervals starting at 24 weeks and analyzed for IL-6 by immnunoassay. A single IL-6 value greater than 250 pg/ml of sample buffer accurately identified 50% of the women who gave birth before 37 weeks gestation, and the absence of elevated IL-6 levels identified 85% of the women who gave birth at term. Vaginal IL-6 levels had less predictive accuracy. A woman with cervical secretion IL-6 levels above 250 pg/ml had 4.8 times the odds of preterm birth. Despite the known involvement of IL-6 in infective processes, elevated IL-6 levels were not associated with mean white blood cell count, the prevalence of vaginal pathogens, alkaline vaginal pH, chorioamnionitis, or endometritis.

Blood levels of alpha-fetoprotein (AFP) may be elevated in women who have multifetal pregnancy reduction. Multifetal pregnancy reduction involves intervention to decrease the fetuses in a multifetus pregnancy. Maternal blood levels of AFP are routinely measured in the second trimester of pregnancy to screen for neural tube defects. Researchers measured blood levels of AFP in 57 women 1 1/2 weeks to 10 weeks after multifetal pregnancy reduction. All the women's blood levels of AFP were significantly higher than those associated with normal twin pregnancies. A coagulation profile was done of 17 patients two to five weeks after multifetal pregnancy reduction. One patient had a positive result on a test for the presence of fibrin split products in her blood. Two had intermediate results, and 14 had negative results. Other aspects of blood coagulation were normal in the women.

The presence of fetal fibronectin in the cervix or vagina may often precede premature delivery. Fibronectin is a protein found in different fetal tissues. Among 326 pregnant women between 24 and 36 weeks pregnant treated at an inner city clinic, 37 (11%) had a premature delivery. All the women had at least one cervical and vaginal sample taken during the 28 days preceding delivery. Of the 37 women who delivered prematurely, 17 had premature rupture of membranes and 20 had premature labor. Sixty-five percent of the women with premature rupture of membranes had a single vaginal sample with more than 50 nanograms (ng) of fetal fibronectin per milliliter (ml). Seventy percent of those with premature labor had more than 50 ng of fetal fibronectin per ml in at least one vaginal sample.

The most frequent intrauterine infections are caused by cytomegalovirus. Symptomatic infection of the fetus most often follows primary (first-time) maternal infection, although it can also occur with reactivated maternal infections. Even though only 10 percent of infected fetuses have symptoms at birth, up to 30 percent die of late complications. Also long-term neurologic problems can later develop in asymptomatic infants. The course of intrauterine cytomegalovirus infections is unclear, and the reason why more than 60 percent of fetuses exposed to primary infection do not become infected is unknown, However, some fetuses are known to be irreversibly harmed before birth. Antiviral agents are now becoming available, and early prenatal diagnosis may allow treatment in utero. Besides virus culturing (isolating the virus from tissue and growing it in the laboratory), new techniques that detect viral DNA and RNA (genetic material) in human tissues have been used to diagnosis viral infections. The experience with prenatal diagnosis of cytomegalovirus infection in 12 fetuses is described. Primary infections occurred in seven of the pregnant women, all of whom had symptoms and antibodies against the virus, but had ultrasound findings that indicated a structurally normal fetus. One infection was diagnosed by culturing virus from amniotic fluid and fetal blood and by the elevated levels of GGTP (gamma-glutamyl transpeptidase), a liver enzyme, indicating liver damage. Five additional fetal infections were suspected because of abnormal ultrasound results such as dilation of ventricles (fluid-filled brain cavities), microcephaly (small skull size), or calcifications within the brain. In addition, fetal blood was tested for total levels of antibodies and antibodies against the virus. Subsequent isolation of virus from fetal tissues confirmed the findings. All of the six infected fetuses died. The study indicates that information from ultrasound, combined with data from amniocentesis and fetal blood sampling allows diagnosis of fetal cytomegalovirus infection. The prognosis of fetuses with normal ultrasound findings, but other signs of infection, is unclear and must await further research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Down syndrome is a congenital, or birth-related, disorder characterized by moderate to severe mental retardation and physical abnormalities, including a sloping forehead, small ear passages, eye discoloration, short broad hands with a single crease in the palm, a flat nose, and a dwarf-like appearance. The incidence of Down syndrome is greater among infants born to mothers over the age of 40 years, mothers with previous pregnancies affected by Down syndrome, and mothers with Down syndrome. Down syndrome can be detected before birth by genetic analysis of fetal tissue. Furthermore, Down syndrome has been associated with elevated levels of alpha-fetoprotein. However, screening programs based on maternal age, alpha-fetoprotein levels, and genetic analysis have only been effective in identifying 60 percent or fewer cases of Down syndrome. Fifty percent of cases of Down syndrome are associated with structural abnormalities, mainly of the heart, which can be detected by ultrasonography. Since ultrasonography, the use of sound waves to visualize internal images, is often performed in pregnant women. The accuracy of ultrasonography in detecting Down syndrome was assessed by a review of the published literature on this topic. Other physical defects that have been used as markers for Down syndrome include the thickening of the nape of the neck and shortening of the thigh bone. Ultrasonographic screening for Down syndrome may only be effective in identifying fetuses with several physical defects. Although ultrasonographic screening in the second trimester of pregnancy is not very sensitive or specific for identifying Down syndrome, it may be a useful addition to screening tests, such as alpha-fetoprotein. (Consumer Summary produced by Reliance Medical Information, Inc.)