Multifetal or Selective Reduction – Benefits, Risks and Precautions

Most people opt for fertility treatments when they are struggling to get pregnant. But where they are expecting one baby, cases arise when a pregnancy might include twins, triplets, or even more babies. Carrying them ahead healthily may not always be possible, and undergoing a pregnancy reduction might be a decision you would have to make. Multifetal reduction, also known as fetal reduction and selective reduction, is a surgical procedure that reduces the number of fetuses, thereby improving the likelihood of a healthy pregnancy and a successful delivery of a healthy baby.

What Is Multifetal Reduction?

A multifetal reduction is a surgical procedure used to reduce the number of foetuses held by a pregnant woman so that the resultant number of foetuses can be carried forward and successfully delivered. It is also termed as selective pregnancy reduction in some cases (1).

Why Is a Foetal Reduction Done?

If getting pregnant is a difficult task in itself, keeping that pregnancy healthy and having an uncomplicated delivery is even more difficult. These become tougher with every fetus that grows within the uterus. Risks of babies being stillborn or premature or having a miscarriage increase rapidly when pregnant with multiples. Some babies may not develop correctly or have birth-related defects. Therefore, a foetal reduction helps keep the risk of delivering babies prematurely due to multiple gestation to a minimum level (2).

Benefits of Multifetal Pregnancy Reduction

There is a strong reason why mothers carrying multiple fetuses think about undergoing a multifetal pregnancy reduction. The benefits that stem from selective embryo reduction are not just beneficial for the other children growing in the mother’s womb, but are also a good way to ensure a great future for the ones that continue ahead in life.

1. Reduced Child Cost

The expenses incurred in caring for multiple children are not affordable for every family. With all children being at the same age, they can quickly shake your financial stability. MFPR can help you keep the costs in a range that works for you.

2. Reduced Mental Stress

While financial problems may be one variable in the equation, caring for multiple children immediately after birth is a challenging task. It can quickly get overwhelming for first-time mothers. Sticking to no more than a couple of babies can help you keep your own mental and physical health in optimal condition to care for the children.

3. Reduced Pregnancy Problems

Every additional foetus that grows within your body not only increases the size of your uterus and tummy, but also stresses your body further in a bid to share resources. Each child taps into the body for resources and has a significant impact on other areas as well. These further increase the chances of anaemia, preeclampsia, or diabetes setting in during pregnancy, ultimately maximising the woman’s health and the health of her surviving neonates.

4. Reduced Pregnancy Risks

While most mothers can deal with pregnancy problems throughout the journey until delivery, most of the significant risks usually emerge at that point. The chances of undergoing a premature delivery, a miscarriage, or the development of congenital disabilities are extremely high when a woman is pregnant with multiple fetuses. Multifetal pregnancy reduction reduces such risks (3).

Risks Associated With MFPR

While multifetal pregnancy reduction has numerous benefits that are good for the mother and the children that will be born, it is not free from foetal reduction risks that might manifest as a result of the procedure itself.

1. Emotional Toll

Some parents develop a strong connection with their foetuses pretty early in the pregnancy. Seeing them in ultrasounds and naming them right away can create a strong bond of parenthood with them. Therefore, undergoing an MFPR can cause a feeling of guilt or sadness for having rejected their own children. Extreme cases can cause depression to manifest within the mother, too, which isn’t good for the remaining babies.

2. The Possibility of an Infection

The MFPR procedure requires external items to come in contact with the tummy or the uterus in order to reduce the number of foetuses in the uterus successfully. As minor as it might be, there is a minuscule probability of an external infection finding its way inside. The incidents are relatively rare, but if an infection does take place, then it can put the remaining foetuses at risk.

3. A Miscarriage of the Complete Pregnancy

In some cases, multifetal reduction may cause the loss of the entire pregnancy (4). Any disturbance to the existing condition of the foetus always opens up the risk factor of miscarriage. In most cases, if the number of fetuses is few, generally around 3 or 4, the chances of miscarriage are minimal, usually around 4% or so. However, as the number of existing foetuses starts increasing, reaching six or more, the risks associated with miscarriage are quite high. Therefore, a decision to proceed with MFPR might need to be taken carefully.

Precautions to Take Before the Multifetal Reduction Process

A pregnancy that consists of multiple fetuses usually occurs after undergoing fertility treatment, involving drugs that put the body in the optimum state for pregnancy. Having made this effort, it might be difficult for you to come to terms with reducing the number of foetuses, as well as opening up to the risk of a miscarriage of the remaining ones. While most fertility clinics do provide this information beforehand, understanding the repercussions of this decision is extremely necessary.

Foetal Reduction Procedure

When opting for a multifetal pregnancy reduction procedure, the timing needs to be right as well. The apt time for carrying out the procedure is within the first trimester. The foetuses are at the initial stage of their growth around this time and are usually located within separate pouches filled with amniotic fluid. They are yet to share a uterus together.

Doctors may use a probe to perform an ultrasound. This technique helps to get a detailed understanding of the foetuses within the uterus, as compared to the normal ultrasound. The probe helps provide the correct positioning of the foetuses within the uterus. Using that as a map, a medical process is initiated to reduce the individual foetuses gently. This makes use of a medicine that is intended to stop the heartbeat of that particular foetus. The correct foetus is determined, with the help of a needle that is inserted through the stomach or the vagina, and the medicine is injected into the foetus’s pouch.

Another alternative is to remove the blood flow received by the foetus from the umbilical cord. Here, your doctor might use the radiofrequency ablation technique, which makes use of electric currents, instead of medicine via the needle.

The number of foetuses to be reduced in a single session depends on your health, the total number of foetuses, and the doctor’s recommendation. Your doctor might give you general anaesthesia throughout the procedure to keep you away from the process, even though it might be over in a few minutes. However, general anaesthesia poses its own side effects and is usually not given to pregnant women.

What to Expect After Selective Reduction?

Once the procedure is completed, you would be asked to stay in the hospital for about 12-24 hours under observation. The remaining foetuses would be observed via ultrasound regularly. A small counselling session might be conducted to gauge your mental well-being.

FAQs

Here are a few questions that are generally on the mind of many women looking to undergo selective pregnancy reduction.

1. Is foetal reduction procedure painful?

Some doctors do give general anaesthesia during the procedure, while others may use only local anaesthesia. In either case, the procedure does not cause much physical pain and is completed within a few minutes.

2. How much does selective reduction cost?

The expenses for the procedure differ from hospital to hospital, depending on the number of foetuses, and the complexity. At times, your fertility clinics might include the cost in their package as an optional service.

3. When is fetal reduction done?

When a couple or an individual opts for fetal reduction, a detailed ultrasound is typically conducted between 11 to 13 weeks of pregnancy to check for any structural abnormalities in the babies. The outcomes of these tests can help patients make informed decisions regarding their intervention options. The procedure is mostly done in the first trimester or early second trimester (4). A 2023 study published in the Journal of Obstetrics, Gynecology & Cancer Research revealed that fetal reduction done in the second trimester by a specialist in twin or multiple pregnancies can yield good outcomes (5).

Moreover, it’s estimated that 8 to 20% of multiple pregnancies may spontaneously reduce by the end of the first trimester. The occurrence of a ‘vanishing’ twin does not negatively impact the fetus that remains.

4. Is there any role of fetal reduction in twin pregnancy?

Certain health conditions, like heart disease or preeclampsia, a history of cervical insufficiency, or uterine anomaly, can significantly increase the risks of carrying a twin pregnancy.  A fetal reduction of a twin pregnancy to a singleton may be appropriate in such cases.

Reducing your existing foetuses is a tricky procedure for the body, but it also affects your emotions. Discuss it with your partner and your doctor before making a decision, and know it is for your best interest and the benefit of the remaining babies.

References/Resources:

1. PubMed Central – Considering multifetal pregnancy reduction in triplet pregnancies: do we forget the emotional impact on fathers? A qualitative study from The Netherlands

2. AJOG – The current status of multifetal pregnancy reduction

3. PubMed Central – Pregnancy Outcomes of Different Methods for Multifetal Pregnancy Reduction: A Comparative Study

4. ACOG – Multifetal Pregnancy Reduction

5. JOGG – Optimal Timing of Multifetal Pregnancy Reduction: The Earlier the Better or Later

Also Read:

Fetal Pole
Fetal Movement
Foetal Monitoring
Fetal Weight during Pregnancy

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