1
|
Ludwigson A, Euser AG, Walsh C, Zahedi-Spung L, S Hirshberg J, French-Stewart L, Scott J, Reeves S, Putra M. Characteristics of Patients Undergoing Fetal Potassium Chloride Injection at a Single Center Over Time. J Womens Health (Larchmt) 2024. [PMID: 39190579 DOI: 10.1089/jwh.2024.0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
Changes in the U.S. laws, particularly the Dobbs decision in 2022, altered access to abortions. Fetal potassium chloride (KCl) injections can be used for second- and third-trimester abortions. This descriptive study aims to present the characteristics of patients who received KCl injections in a state with protective laws (Colorado), including pre- and post-Dobbs. Patients undergoing KCl injection at our institution between January 2014 and December 2023 were included. Records were reviewed for demographic data, parity, and procedure details. Distance traveled and area deprivation index (ADI) were determined based on residence data. Group differences pre- and post-Dobbs were analyzed using Chi-squared and Mann-Whitney U tests. Subanalyses were performed to compare in-state and out-of-state (OOS) patients. One hundred and nineteen patients were included: 56 pre-Dobbs and 63 post-Dobbs, representing a 6.4-fold increase in volume post-Dobbs. Patients were from 10 states of residence pre-Dobbs and 17 post-Dobbs. Median distance traveled significantly increased post-Dobbs, 29.8 versus 383.9 miles (p = 0.004). The maximum distance traveled was 855 miles pre-Dobbs and 1,201 miles post-Dobbs. ADI did not vary pre- or post-Dobbs. Singleton procedures increased post-Dobbs for all patients. There was no change in gestational duration at the time of procedure across any comparison. Procedure volume and distance traveled increased for both in-state and OOS patients with minimal change in patient characteristics pre- and post-Dobbs. Our data indicate an increased need for these procedures, even in a state with protective laws.
Collapse
Affiliation(s)
| | - Anna G Euser
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Caroline Walsh
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Leilah Zahedi-Spung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jonathan S Hirshberg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lindsey French-Stewart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Julie Scott
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shane Reeves
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Manesha Putra
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
2
|
Paudel S, Dahal P, Pant PR, Subedi N. Trans-abdominal fetal reduction in higher order multiple pregnancies: a pioneer cohort retrospective study in Nepal. Ann Med Surg (Lond) 2024; 86:3887-3892. [PMID: 38989206 PMCID: PMC11230800 DOI: 10.1097/ms9.0000000000002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/25/2024] [Indexed: 07/12/2024] Open
Abstract
Objective To share the initial experience of trans-abdominal multifetal pregnancy reduction (MFPR) in Nepal. Method The procedure was performed in 108 patients in a private hospital over a period of 3 years. Under ultrasound guidance, intracardiac injection of 0.2-3.0 ml of 15% w/v (2 mEq/ml) potassium chloride (KCl) was administered via trans-abdominal route. Results A total of 108 fetal reduction procedures were carried out at the seventh to fifteenth weeks of gestation, a maximum of 44 (40.7%) of which were done at the ninth to tenth weeks of gestation. A total of 123 fetuses were reduced. Out of total 108 multifetal pregnancies, 96 (88.8%) were due to in-vitro fertilization (IVF). Eighty-five pregnancies (78.7%) underwent reduction from triplet to twin. The second-time reduction was needed in five cases. Two attempts (in the same sitting) were required in three cases. The inadvertent demise of the second fetus was noted in three cases of dichorionic tri-amniotic triplet pregnancy. Conclusion Ultrasound-guided trans-abdominal fetal reduction performed between the seventh and twelfth weeks of gestation is safe and effective.
Collapse
Affiliation(s)
- Sharma Paudel
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital and Consultant Radiologist at Grande International Hospital
| | | | - Padam Raj Pant
- Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital and Consultant Gynecologist at Grande International Hospital, Kathmandu, Nepal
| | - Nilam Subedi
- Obstetric and Gynecology, Grande International Hospital
| |
Collapse
|
3
|
Ge Y, Lai S, Shi J, Li X, Li X, Chu H, Hu K, Li R, Zhao J. Pregnancy outcomes of fetal reduction in patients with intrauterine haematoma following double embryo transfer. Reprod Biomed Online 2024; 48:103644. [PMID: 38215685 DOI: 10.1016/j.rbmo.2023.103644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 01/14/2024]
Abstract
RESEARCH QUESTION Is there an association between intrauterine haematoma (IUH) and pregnancy outcomes in patients who undergo fetal reduction after double embryo transfer (DET), and if so, what is the relationship between IUH-related characteristics and pregnancy outcomes? DESIGN Clinical information and pregnancy outcomes of women who underwent fetal reduction after DET were analysed. Patients with other systematic diseases, ectopic pregnancy or heterotopic pregnancy, monochorionic twin pregnancies and incomplete data were excluded. Stratification of IUH pregnancies was undertaken based on IUH-related characteristics. The main outcome was incidence of fetal demise (<24 weeks), with other adverse pregnancy outcomes considered as secondary outcomes. RESULTS Thirty-four IUH patients and 136 non-IUH patients who underwent fetal reduction after DET were included based on a 1:4 match for age, cycle type and fertilization method. IUH patients had a higher incidence of early fetal demise (20.6% versus 7.4%, P = 0.048), threatened abortion (48.1% versus 10.3%, P<0.001) and postpartum haemorrhage (PPH; 14.8% versus 4.0%, P = 0.043) compared with non-IUH patients. IUH was an independent risk factor for early fetal demise [adjusted OR (aOR) 3.34, 95% CI 1.14-9.77] and threatened abortion (aOR 8.61, 95% CI 3.28-22.61) after adjusting for potential confounders. IUH pregnancies undergoing fetal reduction that resulted in miscarriage had larger IUH volumes and earlier diagnosis (both P < 0.03). However, IUH characteristics (i.e. volume, changing pattern, presence or absence of cardiac activity) were not associated with threatened abortion or PPH. CONCLUSIONS Fetal reduction should be performed with caution in IUH pregnancies after DET as the risk of fetal demise is relatively high. Particular attention should be given to IUH patients with early signs of threatened abortion and inevitable fetal demise.
Collapse
Affiliation(s)
- Yimeng Ge
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; Peking University Health Science Centre, Beijing, China
| | - Shaoyang Lai
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jing Shi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Xin Li
- Wuhan University of Science and Technology, Wuhan, China
| | - Xiaoxue Li
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Hongling Chu
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Kailun Hu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Rong Li
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
| | - Jie Zhao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
| |
Collapse
|
4
|
Wang X. Fetal reduction, moral permissibility and the all or nothing problem. JOURNAL OF MEDICAL ETHICS 2023; 49:772-775. [PMID: 36813549 DOI: 10.1136/jme-2022-108446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
There is an ongoing debate about whether multifetal pregnancy reduction from twins to singletons (2-to-1 MFPR) is morally permissible. By applying the all or nothing problem to the cases of reducing twin pregnancies to singletons, Räsänen argues that an implausible conclusion seems to follow from two plausible claims: (1) it is permissible to have an abortion and (2) it is wrong to abort only one fetus in a twin pregnancy. The implausible conclusion is that women considering 2-to-1 MFPR for social reasons ought to abort both fetuses rather than just one. To avoid the conclusion, Räsänen suggests that it is best to carry both fetuses to term and give one for adoption. In this article, I argue that Räsänen's argument fails for two reasons: the inference from (1) and (2) to the conclusion rests on a bridge principle that does not work in certain circumstances, and there is good reason to reject the claim that it is wrong to abort only one fetus.
Collapse
Affiliation(s)
- Xueshi Wang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| |
Collapse
|