Multifetal Pregnancy Reduction

Abstract

Fertility treatments have contributed significantly to the increase in multifetal pregnancies. The first approach to the problem of multifetal pregnancies should be prevention and strategies to limit multifetal pregnancies. The goal of multifetal pregnancy reduction is to increase the chance of a successful, healthy pregnancy. Multifetal pregnancy reduction is usually done early in a pregnancy, between the 9th and 12th weeks. It is most often done when there are three or more fetuses present. Multifetal pregnancy reduction is done using intrathoracic injection of potassium chloride or in early pregnancy by aspiration of gestational sac, by both the transabdominal and the transvaginal approaches. No method has yet been proven to be superior to the others. Advantage of transvaginal procedure is the feasibility of the procedure at an earlier gestational age; however, transabdominal approach between 10 and 12 weeks enables a more detailed USG of the fetuses where nuchal thickness can be assessed and chance of spontaneous reduction of multifetal pregnancy is ruled out. Multifetal pregnancy reduction has been described as a “new moral problem” created by the advancement, but not perfection, of assisted reproductive technologies.