Intra Cardiac Injection of Autologous Amniotic Fluid versus Potassium Chloride for Multifetal Pregnancy Reduction

Background: Multifetal pregnancy reduction (MFPR) is a widely practiced procedure aimed at improving pregnancy outcomes and reducing maternal and perinatal complications. Potassium chloride (KCl) injection is the conventional method for MFPR, however its use carries certain risks. Autologous amniotic fluid (AF) injection has been proposed as a potentially safer alternative.
Aim: This study aimed to compare the efficacy and safety of intra-cardiac injection of autologous amniotic fluid versus potassium chloride for multifetal pregnancy reduction.
Methods: A randomized prospective study was conducted on 42 women with multifetal pregnancies (≥ triplets) undergoing MFPR between 8–12 weeks of gestation. Patients were randomized into two groups: Group A (n=21), received intra-cardiac AF injection and group B (n=21), received KCl injection. The primary outcome was the success rate of fetal reduction, defined as achieving twin pregnancy post-procedure. Secondary outcomes included miscarriage rates, gestational age at delivery, neonatal birth weight, and procedure-related complications.
Results: Both techniques were equally effective in achieving successful reduction to twins. The KCl group required significantly lower doses and shorter time to achieve asystole. However, the AF group demonstrated better pregnancy outcomes, including higher mean gestational age at delivery and increased neonatal birth weight. Early and late miscarriage rates, as well as take-home baby rates, were comparable between the two groups.
Conclusion: Intra-cardiac injection of autologous amniotic fluid was a safe and effective alternative to potassium chloride for multifetal pregnancy reduction. Although KCl achieved faster procedural success, AF injection was associated with more favorable perinatal outcomes. Larger multicenter studies are needed to validate these findings and assess long-term neonatal outcomes.