To explore the clinical application of selective fetal reduction guided by transvaginal ultrasound in multiple pregnancies.

A retrospective analysis was performed on 52 cases of multiple pregnancies within 10 weeks from January 2013 to December 2018 at the Reproduction Medical Center of our hospital. All patients underwent selective reduction under the guidance of transvaginal ultrasound. After operation, they were divided into either a single-fetus group or a multiple-fetus group. In addition, 82 cases of single and twin pregnancies within 10 weeks after treatment were randomly selected as a single-fetus control group and multiple-fetus control group, respectively. Fetal birth weight, low birth weight rate, premature birth rate, and late abortion rate, as well as the related complications during pregnancy, including gestational diabetes mellitus, gestational hypertension, postpartum hemorrhage, and premature rupture of membranes, were recorded. The four groups of subjects were compared for the above indicators.

The successful rate of fetal reduction in the 52 cases of multiple pregnancies was 100%. In the twin pregnancy group after fetal reduction, there was one case of early spontaneous abortion and four cases of late spontaneous abortion. The incidence of fetal birth weight in the multiple-fetus group was significantly lower than that in the single-fetus group [(2.52±0.48) kg vs (3.41±0.31) kg, t=2.495, P<0.05], while the low birth weight rate was significantly higher than that in the single-fetus group (35.5% vs 6.3%, χ²=3.916, P<0.05). The late abortion rate and premature delivery rate in the multiple-fetus group were significantly higher than those in the single-fetus group (25.7% vs 0; 33.3% vs 0, P=0.043、0.013). Both the single-fetus group and multiple-fetus group had similar birth weight, low birth weight, late abortion rate, and premature delivery rate compared with their respective control groups (P>0.05). There was no difference between the single-fetus group and multiple-fetus group in pregnancy hypertension, gestational diabetes mellitus, or postpartum hemorrhage (P>0.05), but the incidence of premature rupture of membranes was significantly higher in the multiple-fetus group than in the single-fetus group (45.2% vs 6.3%, χ²=5.672, P=0.017).

Vaginal ultrasound-guided selective fetal reduction can significantly improve the pregnancy outcome of multiple pregnancies, representing a safe and effective clinical procedure.