Foetal Reductions Complications

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Mark Perloe, MD: “I’m Mark Perloe and I’m here at the American Society of Reproductive Medicine meeting in Seattle with Dr. Sonia Malik. Dr. Malik had a poster presentation on complications associated with foetal reduction. I think many of us in the IVF world, more and more, are concerned that the need for foetal reduction in itself is a complication but we frequently will refer the patient to the perinatologist hoping for the best but sometimes that’s not the case. Can you tell us a bit about your poster?”

Sonia Malik, MD: “This particular poster is a little unique in the sense that this complication is something which will not happen automatically. We had attempted a foetal reduction, and due to a complication, which took place while I was attempting the procedure, I had to abandon the procedure and we couldn’t go in and do it again so we couldn’t complete the procedure. Subsequently this led to the birth of a live baby and that is what this poster is all about: the congenital malformation of the deformities that took place subsequent to the incomplete foetal reduction.”

Mark Perloe, MD: “Can you tell us a little bit more about the complication that arose that prevented completing the procedure?”

Sonia Malik, MD: “This was a quintuplet pregnancy, there were five sacs. I had managed to reduce two foetuses and when I entered the third sac I inadvertently entered a vessel, a uterine vessel, and there was a large haematoma formed immediately on my entering the vessel and that is why I stopped, and told the patient that I would not be able to complete the procedure but that we would subsequently be doing it. She started bleeding, the bleeding settled down in about two weeks time. It took a long time for the whole thing to settle down but in the meantime the liquor of that particular sac also drained and we sort of presumed that now, since the liquor is gone and the heartbeat of the baby was fluctuating between 70 to 80, we thought that this baby would no longer survive. But it started reforming liquor at 18 weeks of…between 14 to 18 weeks of pregnancy. And that’s when I told the parents, that we would want to go in and do it again, because this seems to be carrying on but then, for superstitious reasons and religious beliefs that this baby has to come, they wouldn’t sign. They didn’t give consent for the subsequent intervention and I don’t know how, but we had to sort of know that this might affect the baby; the foetus is going to have some kind of problems. We had to carry on because they just wouldn’t agree to our intervention again.”

Mark Perloe, MD: “How has this affected your willingness to refer, or in any way how you perform, the procedure? Has this changed your feelings about the applicability or, would you do something different based on your experience?”

Sonia Malik, MD: “Yes, yes, definitely. You see, what I feel is that this kind of a thing has never happened before. I think this is the first time I am reporting a case like this. And what I feel is that physicians, who are attempting to do this procedure, will have to be more firm in taking consent and they would have to explain, very explicitly – what exactly – could happen to the baby, in case it goes wrong. Although, what I feel is that most of the deformities that happened were as a result of the draining of the liquor because, it’s a girl child, it had a lot of contractures, including webbing of the neck, contracture of the arm, contractures of the feet. Most of the deformities were because of the draining of the liquor. She’s now there for a couple of weeks but then she also has kyphus scoliosis and I can’t say that I didn’t injure the spine.”

Mark Perloe, MD: “Well, I think that it’s just more evidence that we need to look at the doses and number of embryos we transfer.”

Sonia Malik, MD: “Definitely.”

Mark Perloe, MD: “Be cautious about applying this procedure.”

Sonia Malik, MD: “Absolutely, and I think the less we use this procedure the better it would be.”

Mark Perloe, MD: “Thank you so much for coming and sharing your experience.”

Sonia Malik, MD: “Thank you sir.”