382 SPO Abstracts

304 LONGTERM PSYCHOLOGICAL EFFECT OF MUL TIFETAL PREGNANCY REDUCTION. L.....Lm£b.. P. Schreiner-Engelx• V. Waltherx. M. Alvarez. R.L. Berkowitz. Dept.OblGyn. Mount Sinai School of Medicine. NY. NY. OBJECTIVE: To determine the long term psychological effect of mult~etal pregnancy reduction (MPR). STUDY DESIGN: 82 of the first 100 consecutive women who underwent a MPR and subsequently delivered were interviewed by telephone by one of the authors (a psychologist or social worker) using an extensive semi-structured questionnaire. Ten of the 100 women had miscarried. four were lost to follow-up and five refused to be interviewed. One patient had two pregnancies reduced and had both a spontaneous abortion and a term pregnancy. Those who miscarried were also interviewed but the data will be presented separately. RESULTS: The most sign~icant resu~s included: Mourning for reduced fetus(es) was experienced by 70% for a period lasting a mean of 3.2 months (range 3 days to 30 months); 92% would make the same decision for a MPR again. and 3% were ambivalent. Only 37"10 had an anniversary reaction to MPR. MPR was kept a secret by 64% and 17% have decided to tell the surviving children about the MPR. although 43% are undecided whether to tell. Feelings of mild guilt and moderate sadness persist for most patients; none expressed symptoms of depressed mood. Overall impact of MPR on the marital relationship was minimal and no impact on sexual relationships was found. Attachment to surviving fetuses was not impaired. CONCLUSIONS: (1) Mhough most patients experienced mourning for a short period immediately after the MPR. no long term strong negative feelings persisted. (2) Most patients regret the need for an MPR and feel sad that fetuses had to be lost to preserve a few. but would choose to do ~ again in a similar situation. (3) MPR does not have a deleterious effect on the mar~al relationship or the mother's bonding w~h the surviving children.

305 MATERNAL SERUM ALPHA-FETOPROTEIN AND COAGULATION PROFILES AFTER MULTIFETAL PREGNANCY REDUCTION. L.....L.ws;h. R.L. Berkowitz, Dept. Ob/Gyn. Mount Sinai School of Medicine, NY, NY. OBJECTIVE: The presence of a retained dead fetus has been associated with elevations in maternal alpha-fetoprotein (MSAFP) and disseminated intravascular coagUlation (DIC). We sought to determine the effect of first trimester multifetal pregnancy reduction (MPR) on MSAFP and coagulation profiles (CP) in the second trimester. STUDY DESIGN: MSAFP was determined in 57 patients and CP in 17 patients. The innial number of fetuses ranged from 3-9 and all except one had viable twins when MSAFP and CP were drawn. One patient had only one living fetus because one of her twins had Turner syndrome and died 2 weeks prior to the MSAFP. RESULTS: No surviving fetuses had abnormalities associated wnh increased MSAFP. Gestational age at MSAFP: 16.3 (± 1.2) weeks. Weeks between MSAFP and MPR: 4.4 (± 1.4) weeks (range 1.5-10 weeks). Mean MSAFP: 11.6 (± 7.6) MOMS (range 3.9-46.6). MSAFP MOMS and number of dead fetuses: r _ 0.52. P _ .0001. MSAFP MOMS and weeks between MSAFP and MPR: r z - 0.31, P - .02. Coagulation profiles: drawn 2-5 weeks post procedure. Fibrin spl~ produ~s (FSP) > 40 (positive): 1/17, < 10-40 (borderline): 2/17. < 10 (negative): 14/17. All other coagulation parameters were normal and clinical evidence of disseminated intravascular coagulation was not present. CONCLUSIONS: (1) MSAFP is always elevated after MPR and the elevation is caused by and correlated with the number of dead fetuses. (2) MSAFP cannot be used for screening these patients for neural tube defects or pregnancy complications. (3) Fibrin split products can occasionally be elevated after MPR. but the clinical significance of this finding is unclear.

January 1993 Am J ObSlCl Gyneco1

306 STUClt TWIN SYNDROME: OUTCOME IN THIRTY-EIGHT CONSECUTIVE CASES. DP Reisner, BS MahonyX, CN Petty, DA Nyberg", RW Zingheimx, MA Williamsx, DALuthy. Swedish Medical Center, Seattle, Washington. OBJECTIVE: To further evaluate the role of serial amniocenteses (SA) on survival in Stuck Twin Syndrome (STS). STUDY DESIGN: A cohort of 38 consecutive cases of STS were evaluated over 6 years. outcomes included gestational age (GA) at diagnosis, GA at delivery, mean number SA, mean amniotic fluid volume (AFV) withdrawn, and perinatal complications. OUtcomes were compared to those previously published in untreated Stuck Twin Syndrome. RESULTS: 4 pregnancies were terminated, 7 had no intervention, and 27 underwent serial amnios. The mean number amnios were 3.5 (range 1-7), and mean AFV withdrawn was 1.9 literS/SA (range 0.4-3.5). Mean GA at diagnosis was 23.2 weeks (range 15-30) and 30.1 weeks at delivery (range 18-40). Placental pathology confirmed 4 diamniotic/ dichorionic and 24 diamniotic/monochorionic placentae. Pregnancy complications included preterm labor, dividing membrane defect, ruptured membranes, chorioamnionitis, and abruption. survival was 4/14 (29%) in the no intervention group and 40/54 (74%) in the serial amnio group (9 fetal and 5 neonatal deaths) • CONCLUSION: Serial amniocenteses appear to improve outcome in Stuck Twin Syndrome.

307 MANAGEMENT OF SEVERE TWIN TRANSFUSION SYNDROME. R.Molina, F. Sherman,' S. Laifer. Dept.Ob/Gyn and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. OBJECTIVE: Our objective was to determine whether serial amniocenlellis improves the outcome in pregnancies complicated by severe Twin Tl1IDBfusion Syndrome (TfS) in which perinatal mortality rate approximates 80-90 % . SI'UDY DESIGN: Nine women with severe TIS, defined as twin Ilestaticn. with fetuses of same sex, amniotic sacs with oIillOOYdramoios (stuck twin) and polyhydramnios, presenting at less than 28 weeks Ilestation, were followed prospectively. Amniocenlellis was performed when polyhydramnios was present, and all pregnancies were followed with serial biophysical profiles and fetal echocardiography, RESULTS: Patients required between 1 and 12 amniocenteses. Mean (SO) Ilestational ages at first amniocentesis and delivery were 23.1 (4.6) and 30.7 (3.3) weeks, respectively. Amniotic fluid reaccumulated around the donor twin in all cases. Echocardiography invariably demonstrated ventricular hypertrophy and dilation in the recipient twin. There was a single case of twin fetal death in which the donor twin developed pulmonary atresia, and one case each of sinllle fetal death and twin neonatal death occurred. Perinatal survival was 72 % with 7/9 donors and 6/9 recipients surviving. CONCLUSIONS: Serial amniocentesis improves perinatal survival in pregnancies complicated by TIS.