article · Australian Journal of Biomedical Research
Higher-order multiple pregnancies resulting from assisted reproduction carry heightened risks of complications such as preterm birth and growth restriction. A retrospective study in Lagos, Nigeria evaluated outcomes for twenty-three women with triplet or quadruplet pregnancies who received ultrasound-guided multifetal reduction between 2014 and 2024. The procedure used ultrasound-guided cardiac puncture and gestational sac aspiration without potassium chloride injection. Nineteen procedures took place before eight weeks of gestation, while four occurred at or after eight weeks. Immediate vaginal bleeding was recorded in two patients, with no immediate miscarriages. Overall, early intervention yielded superior outcomes: women undergoing reduction before eight weeks achieved a one hundred per cent take-home-baby rate, compared to seventy-five per cent for later interventions. Performing the reduction earlier also correlated with higher birth weights and reduced occurrences of preterm labour, premature membrane rupture, and small-for-gestational-age infants.
Multiple pregnancies resulting from fertility treatments present serious maternal and neonatal health risks. Evidence regarding multifetal pregnancy reduction techniques in sub-Saharan Africa has been scarce. Demonstrating that an early ultrasound-guided technique without potassium chloride can produce favourable delivery outcomes provides clinicians and patients in the region with practical clinical data for managing high-order gestations safely.
This clinical research reflects an applied and tested medical procedure already in use within a specialist fertility centre. The primary users are reproductive healthcare providers and fertility clinics seeking safe clinical protocols for managing high-order multiple gestations. While it evaluates a procedural technique rather than a proprietary commercial product, the findings offer clinical guidance that specialised fertility practices in sub-Saharan Africa can directly adopt to standardise patient care.
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Background: Higher-order multifetal pregnancies following assisted conception are associated with increased risks of miscarriage, preterm birth, fetal growth restriction and neonatal morbidity. Multifetal pregnancy reduction may improve outcomes, but evidence from sub-Saharan Africa remains limited. Methods: This retrospective cohort study included women who underwent ultrasound-guided multifetal pregnancy reduction at Kingswill Specialist Hospital, Lagos, Nigeria, between January 2014 and December 2024. All pregnancies followed assisted reproductive treatment. Reduction was performed between 6 and 12 weeks using ultrasound-guided cardiac puncture followed by aspiration of the selected gestational sac, without potassium chloride injection. Maternal characteristics, procedural details, pregnancy and perinatal outcomes were extracted from clinical records and compared according to reduction before or at/after 8 weeks. Results: Twenty-three women underwent multifetal pregnancy reduction. Mean maternal age was 32.8 ± 2.3 years, and median parity was 1 (interquartile range 0–2). Seventeen pregnancies (73.9%) were triplets and six (26.1%) were quadruplets. Reduction was performed before 8 weeks in 19 women (82.6%) and at/after 8 weeks in four (17.4%). Immediate post-procedure vaginal bleeding occurred in two women (8.7%), and no immediate post-procedure miscarriage was recorded. The take-home-baby rate was 100.0% before 8 weeks and 75.0% at/after 8 weeks. Earlier reduction was associated with higher mean birth weight, lower preterm prelabour rupture of membranes, lower preterm labour and fewer small-for-gestational-age births. No neonatal deaths or congenital malformations were recorded. Conclusion: Ultrasound-guided multifetal pregnancy reduction was feasible and associated with favourable outcomes in this Nigerian fertility centre.
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DOI: 10.63946/aubiomed/19196
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