Selective reduction

Not to be confused with Selective catalytic reduction.
Monoamniotic triplets, a very rare condition where the triplets share a single placenta, seen on ultrasound. Because a single placenta has difficulty supporting multiple fetuses, in such cases a selective reduction to improve the likelihood of survival for the remaining fetus or fetuses may be indicated.[1][2]

Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. The procedure is also called multifetal pregnancy reduction.[3] The procedure is most commonly done to reduce the number of fetuses in a multiple pregnancy to a safe number, when the multiple pregnancy is the result of use of assisted reproductive technology; outcomes for both the mother and the babies are generally worse the higher the number of fetuses.[4] The procedure is also used in multiple pregnancies when one of the fetuses has a serious and incurable disease, or in the case where one of the fetuses is outside the uterus, in which case it is called selective termination.[4]

The procedure generally takes two days; the first day for testing to select which fetuses to reduce, and the 2nd day for the procedure itself, in which potassium chloride is injected into the heart of each selected fetus under the guidance of ultrasound imaging.[5] Risks of the procedure include bleeding requiring transfusion, rupture of the uterus, retained placenta, infection, a miscarriage, and prelabor rupture of membranes. Each of these appears to be rare.[4]

Selective reduction was developed in the mid-1980s, as people in the field of assisted reproductive technology became aware of the risks that multiple pregnancies carried for the mother and for the fetuses.[6][7]

  1. ^ "UOTW #19 - Ultrasound of the Week". Ultrasound of the Week. 23 September 2014. Archived from the original on 9 May 2017. Retrieved 27 May 2017. Triplets
  2. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
  3. ^ "Opinion Number 719: Multifetal Pregnancy Reduction". American College of Obstetricians and Gynecologists’ Committee on Ethics. September 2017. Archived from the original on 2019-04-04. Retrieved 2018-10-26.
  4. ^ a b c Legendre, Claire-Marie; Moutel, Grégoire; Drouin, Régen; Favre, Romain; Bouffard, Chantal (2013). "Differences between selective termination of pregnancy and fetal reduction in multiple pregnancy: A narrative review". Reproductive BioMedicine Online. 26 (6): 542–54. doi:10.1016/j.rbmo.2013.02.004. PMID 23518032. Open access icon
  5. ^ Evans, MI; Andriole, S; Britt, DW (2014). "Fetal reduction: 25 years' experience". Fetal Diagnosis and Therapy. 35 (2): 69–82. doi:10.1159/000357974. PMID 24525884. S2CID 5136936. Open access icon
  6. ^ Mundy, Liza (May 20, 2007). "Too Much to Carry?". Washington Post Magazine. Archived from the original on April 5, 2015.
  7. ^ Padawer, Ruth (August 10, 2011). "The Two-Minus-One Pregnancy". New York Times Magazine.