Learn about the fetal reduction procedure and its role in ensuring a safe pregnancy.

Summary

• Fetal Reduction is a procedure used to reduce the number of fetuses in a multiple pregnancy, usually to two.
• This is because when a pregnancy involves three or more fetuses, the risks of miscarriage, stillbirth, and structural malformation increase with each additional fetus.
• The doctor under ultrasound guidance, inserts a needle through the mother’s  abdomen and into the uterus to the selected fetus. The doctor injects the fetus with a potassium chloride which stops the fetal heart.
• In cases where a multi-fetal pregnancy of three or more fetuses is reduced to two fetuses, the remaining fetuses develop as they would if they had been conceived as twins.
• The procedure usually does not have any adverse effect on the surviving fetus.

Why is the procedure done?

Fetal Reduction 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, the risks of miscarriage, stillbirth, and structural malformation increase with each additional fetus.

Fetal reduction refers to choosing to reducea fetus in a multiple pregnancy, to decrease the health risks to the mother in carrying and giving birth to more than one or two babies, and to also decrease the risk of complications to the remaining fetuses.

The chance of multiple pregnancy increasesin case of artificial reproductive techniques. The aim of an IVF is to both achieve and sustain a safe pregnancy that results in a healthy baby.

As the number of fetuses increases, the risks of preterm delivery also increase: the average length of pregnancy is known to reduce as the number of fetuses increase. for a singleton is 40 weeks whereas for twins it is 36 weeks. This reduces dramatically to 32 to 33 weeks for triplets and 28 to 29 weeks for quadruplets.The goal of Fetal Reductionis to increase the chance of a successful, healthy pregnancy. Fetal Reduction:

• Is usually done early in a pregnancy, between 11 to 14 weeks.
• Is most often done when there are threeor more fetuses present.
• Can be used to reduce triplets to twins.
• Is known as "selective termination" when it involves a fetus with severe defects or one which would threaten the life of the surviving fetus or fetuses.

When is the procedure typically done?

It is usually done between 11 to 14weeks of pregnancy. It could be done in combination with the first trimester screening. The procedure usually does  not have any adverse effect on the surviving fetus.

How is the procedure done?

• The most common method of fetal reduction is transabdominal (through the abdomen). For this procedure, the doctor uses ultrasound as a guide and inserts a needle through the mother’s abdomen and into the uterus to the selected fetus. The doctor injects the fetus with a potassium chloride/ lignocaine solution, which stops the fetal heart.
• Because it is very small during the first trimester, the reduced fetus is usually absorbed by the mother's body. This may include some vaginal bleeding.

How is the fetus selected?

While performing the routine screening ultrasound at 12 to 13 weeks, the fetus which displays signs of an abnormality is selected for reduction. In case all the fetuses appear normal during the ultrasound scan, then the fetus that is easily approachable is targeted for reduction. It must be noted that fetuses are not selected based on gender. This is strictly prohibited under PCPNDT law and the sex of the fetuses are not revealed and is also not studied.

What are the risks involved?

In a higher-order multiple pregnancy(three or more), the risks of malformation or intra-uterine death are higher with each additional fetus. While fetal reduction increases the chances of healthy survival for the remaining fetuses, it may sometimes lead to miscarriage of the remaining fetuses, preterm labor or infection.

About 75% of women who undergo fetalreduction will go into premature labor. About 4-5% of women undergoing fetalreduction also miscarry one or more of the remaining fetuses. Other side effects include fever, vaginal bleeding, leaking or contractions.

To be noted:

In cases where a multi-fetal pregnancy of three or more fetuses is reduced to two fetuses, the remaining fetuses develop as they would if they had been conceived as twins.

Counseling is recommended after the procedurebecause fetal reductionis a traumatic event. The patient and her family may feel guilty about undergoing the procedure.