Knowledge | What is multifetal reduction? A procedure to improve pregnancy safety
As assisted reproduction becomes more common, more women conceive twins, triplets, or higher-order multiples after treatment. Multiple pregnancy carries higher risks, so doctors may recommend multifetal reduction to improve fetal survival and protect maternal health.
Also called fetal reduction or selective reduction, the procedure reduces the number of fetuses in the uterus, lowering the risks of miscarriage, preterm birth, stillbirth, and maternal and fetal complications. Although procedural risk is low, the decision can be emotionally difficult.
Why is fetal reduction performed?
Pregnancy with three or more fetuses presents greater challenges, including:
Substantially higher miscarriage or stillbirth risk, especially later in pregnancy;
Much higher preterm-birth risk, which may leave the lungs, heart, stomach, and brain underdeveloped;
Potential lifelong conditions such as cerebral palsy, intellectual disability, and impaired vision or hearing;
Higher maternal risks, including severe pregnancy symptoms, constipation, gestational diabetes, hypertension or preeclampsia, anemia, and life-threatening complications such as placental abruption.
Doctors generally recommend reduction early in pregnancy, at about 12 weeks or earlier, to improve the remaining fetuses' survival and protect the pregnant patient.
How is it performed?
Reduction usually occurs in the first trimester while each fetus is in a separate amniotic sac. Ultrasound identifies the fetuses, and image guidance is used to insert a fine needle through the abdomen or vagina. Medication is injected into the selected fetus's sac to stop its heartbeat.
In some cases, radiofrequency ablation uses a small electrical-current device to interrupt blood flow through the selected fetus's umbilical cord.
The procedure usually takes only minutes. General anesthesia may be used to prevent pain. Ultrasound is repeated afterward to confirm that the remaining fetuses are stable.
Some patients may remain in the hospital overnight.
Potential risks and aftercare
Complications are uncommon but may include:
Post-procedure infection, which is extremely rare;
A slightly higher miscarriage risk;
Continued risk of preterm birth.
Care plans for the remaining fetuses may include:
A high-calorie, high-protein diet;
Medication when needed;
More bed rest;
More frequent prenatal visits and monitoring.
Patients should closely follow medical instructions to reduce complications and protect the pregnancy.
An emotional decision
For couples who struggled to conceive, choosing reduction can create intense emotional distress: after working toward pregnancy, they face reducing the number of fetuses. This conflict can be heartbreaking and confusing.
Doctors recommend thorough discussion before the procedure and consideration of professional counseling. Understanding the medical options and openly discussing feelings can help couples make the decision best suited to them.
Knowledge | What is multifetal reduction? A procedure to improve pregnancy safety
Knowledge | What is multifetal reduction? A procedure to improve pregnancy safety
As assisted reproduction becomes more common, more women conceive twins, triplets, or higher-order multiples after treatment. Multiple pregnancy carries higher risks, so doctors may recommend multifetal reduction to improve fetal survival and protect maternal health.
Also called fetal reduction or selective reduction, the procedure reduces the number of fetuses in the uterus, lowering the risks of miscarriage, preterm birth, stillbirth, and maternal and fetal complications. Although procedural risk is low, the decision can be emotionally difficult.
Why is fetal reduction performed?
Pregnancy with three or more fetuses presents greater challenges, including:
Substantially higher miscarriage or stillbirth risk, especially later in pregnancy;
Much higher preterm-birth risk, which may leave the lungs, heart, stomach, and brain underdeveloped;
Potential lifelong conditions such as cerebral palsy, intellectual disability, and impaired vision or hearing;
Higher maternal risks, including severe pregnancy symptoms, constipation, gestational diabetes, hypertension or preeclampsia, anemia, and life-threatening complications such as placental abruption.
Doctors generally recommend reduction early in pregnancy, at about 12 weeks or earlier, to improve the remaining fetuses' survival and protect the pregnant patient.
How is it performed?
Reduction usually occurs in the first trimester while each fetus is in a separate amniotic sac. Ultrasound identifies the fetuses, and image guidance is used to insert a fine needle through the abdomen or vagina. Medication is injected into the selected fetus's sac to stop its heartbeat.
In some cases, radiofrequency ablation uses a small electrical-current device to interrupt blood flow through the selected fetus's umbilical cord.
The procedure usually takes only minutes. General anesthesia may be used to prevent pain. Ultrasound is repeated afterward to confirm that the remaining fetuses are stable.
Some patients may remain in the hospital overnight.
Potential risks and aftercare
Complications are uncommon but may include:
Post-procedure infection, which is extremely rare;
A slightly higher miscarriage risk;
Continued risk of preterm birth.
Care plans for the remaining fetuses may include:
A high-calorie, high-protein diet;
Medication when needed;
More bed rest;
More frequent prenatal visits and monitoring.
Patients should closely follow medical instructions to reduce complications and protect the pregnancy.
An emotional decision
For couples who struggled to conceive, choosing reduction can create intense emotional distress: after working toward pregnancy, they face reducing the number of fetuses. This conflict can be heartbreaking and confusing.
Doctors recommend thorough discussion before the procedure and consideration of professional counseling. Understanding the medical options and openly discussing feelings can help couples make the decision best suited to them.
Source:
Collected online