Trends of Selective Fetal Reduction and Selective Termination in Multiple Pregnancy, in England and Wales: a Cross-Sectional Study

Sreya Sam,Sarah Tai-Macarthur,Panicos Shangaris,Srividhya Sankaran

doi:10.1007/s43032-021-00819-5

Abstract

Selective abortion was shown to be increasingly common in England and Wales over a 9-year period, occurring most frequently as twin to singleton reductions in the 1st trimester. We analysed the trends in selective abortion (SA) in multiple pregnancies in England and Wales between 2009 and 2018. This is a cross-sectional study looking at 1143 women with multiple pregnancies in England and Wales undergoing SA. There were a total of 1143 cases of SA between 2009 and 2018 in England and Wales, representing 0.07% of total abortions. There has been a steady increase in cases, from 90 in 2009 to 131 in 2018, with 82.3% justified under ground E of The Abortion Act 1967. The majority of SAs were carried out at 13–19 weeks gestation, and intracardiac injection of potassium chloride was the most prevalent method (75%). Twin to singleton reductions accounted for 59%, the most common form of SAs. Over half of all cases (59%) were performed in women aged 30–39 years, and 84% of all women were of White ethnicity. SA has been an option available for couples diagnosed with multiple pregnancy, especially when there are discordant anomalies. Although SA may decrease multiple pregnancy-related complications, preventative methods must be championed.

Highlights

Multiple pregnancy, defined as a pregnancy in which more than one fetus develops, accounts for approximately 3% of all live births worldwide [1, 2]
The prevalence of multiple pregnancies and their associated complications has drastically increased since the rise of assisted reproductive technologies (ART)
Selective fetal reduction (SFR) has been developed as a solution to try and minimise these risks for both mother and baby

Summary

Introduction

Multiple pregnancy, defined as a pregnancy in which more than one fetus develops, accounts for approximately 3% of all live births worldwide [1, 2]. In 2018, there were a total of 10,005 multiple births in England and Wales, of which 99% were twins and 1% triplets [4]. This uptick in cases may be attributed to the rise in assisted reproductive technologies (ART), which has been shown to predispose to multiple pregnancies [5]. The incidence of monozygotic twins is estimated to increase threefold after ovulation induction or conventional IVF and 13-fold after intracytoplasmic sperm injection [7]. This increasing incidence of multiple pregnancies may be of concern due to their association with high-risk complications [8]

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Conclusion