Multifetal pregnancy reduction (MFPR) is a procedure used
to reduce the number of fetuses in a multiple pregnancy, usually to two. When a
pregnancy involves three or more fetuses (high-order pregnancy), the risks of
miscarriage, stillbirth, and lifelong disability increase with each additional
Assisted reproductive technology (ART) and
fertility drugs have greatly increased the number of
The goal of MFPR is to increase
the chance of a successful, healthy pregnancy. Multifetal pregnancy
- Is usually done early in a pregnancy, between the 9th and 12th
- Is most often done when there are four or more fetuses
- Can be used to reduce triplets to twins.
- Is known as "selective
termination" when it involves a fetus with severe defects or one that is
expected to die later in the pregnancy, which would threaten the life of the
surviving fetus or fetuses.
The most common method of fetal reduction
is transabdominal (through the belly) MFPR. For this procedure, the doctor uses
ultrasound as a guide and inserts a needle through the
woman's abdomen and into the uterus to the selected fetus. The doctor injects
the fetus with a potassium chloride solution, which stops the fetal heart.
Because it is very small during the first trimester, the
dead fetus is usually absorbed by the mother's body. This may include some
vaginal bleeding. This absorption process is the same process that happens in
vanishing twin syndrome.
When there are three or more fetuses in the uterus, their risks of disability or death are higher with each additional fetus. A successful MFPR increases the chances of healthy survival for the remaining fetuses and reduces risks to you. But MFPR sometimes leads to miscarriage of the remaining fetuses, preterm labor, or infection.
What to think about
The decision to have a multifetal pregnancy reduction is difficult and traumatic. If you are faced with this decision, talk to your doctor about your personal risks from trying to carry multiple fetuses to term compared to the risks of choosing MFPR. Also consider discussing your decision with a counselor or spiritual adviser.
- Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?
The American Society for
Reproductive Medicine and the American Congress of Obstetricians and
Gynecologists strongly recommend careful use of infertility treatment in the
effort to avoid the risks of a triplet-or-more pregnancy and of MFPR. When
embryos are transferred to the uterus, this means limiting the number of
embryos that are transferred for each treatment cycle.