Transabdominal multifetal pregnancy reduction: report of 40 cases

Article Abstract:

New reproductive technologies that require the use of drugs to stimulate ovulation or the transfer of multiple embryos (in vitro fertilization) have increased the chances of conceiving more than one fetus. A pregnancy involving three or more fetuses runs the risk of maternal high blood pressure, premature delivery, a complicated delivery or total pregnancy loss. In an effort to reduce the risks associated with multiple fetuses, a procedure that selectively reduces the number of fetuses can be performed, which is known as multifetal pregnancy reduction. Multifetal pregnancy reduction offers hope to couples who may not have the chance for another pregnancy. Transabdominal fetal reduction was performed on 40 pregnancies between the 11th and 13th weeks of pregnancy. There were 23 sets of triplets, 13 of quadruplets and 4 of quintuplets; all but 2 were reduced to twins (1 triplet pregnancy was reduced to a singleton, and 1 quintuplet was reduced to a triplet). As of this report, there have been 28 deliveries: 27 twins and 1 set of triplets. The remaining 12 had not yet delivered. None of the women lost the entire pregnancy after the procedure. The average age at delivery was 35 weeks; 10 delivered after 37 weeks, 16 delivered (57 percent) between 33 and 36 weeks and 2 delivered before the 33rd week (7 percent). One infant, delivered at 27 weeks, died from complications of prematurity, while its twin survived. Another twin died from fetal growth retardation, while its twin survives. Multifetal pregnancy reduction is a safe treatment option for couples faced with the difficult decision of losing the entire pregnancy or risking the chance of severe complications of prematurity. Although there are many ethical and moral issues surrounding selective termination, early pregnancy termination is a patient's legal right while the fetuses are not viable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Complications and side effects, Pregnancy, Complications of, Pregnancy complications

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Selective reduction: an unfortunate misnomer

Article Abstract:

Improvements in reproductive technologies have increased the chances of conceiving a pregnancy with more than one fetus. In many cases more than three fetuses are involved, increasing the chances of total pregnancy loss, maternal complications, or suffering the consequences associated with prematurity. The termination of one or more fetuses has been termed selective reduction. Originally, the procedure was used to selectively terminate an abnormal fetus on the basis of defective chromosomes. However, the individual characteristics of the fetuses terminated in procedures performed purely to reduce the number of fetuses in a multiple pregnancy are rarely known. Selective termination of a fetus, as it is performed today, is not necessarily selected on the basis of fetal abnormalities, but rather by the location of the fetus within the uterus. Since the terminations are performed early in pregnancy, chromosomal analysis by amniotic fluid or chorionic villi sampling is hindered by the number of fetuses. Patients preparing for the procedure are told in advance that fetal sex and fetal chromosomal make-up are not known prior to selective termination. In the recent promotion of a television show reporting on a woman who had successfully undergone a reduction from nine to two fetuses, viewers were to be asked how they would feel about making the decision as to which fetuses should be terminated. Understandably the couple involved were disturbed by this and the producers decided not to use the viewer lure, but not after having to be convinced that this was a sensitive issue. Although selective termination is a commonly used term, it is a misnomer that could be psychologically damaging to couples making an already difficult decision. It is suggested that the term selective termination be replaced by the term multifetal pregnancy reduction (MPR). (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Medicine, Terminology, editorial

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