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Selective reduction.

Mark I Evans1, Eric L Krivchenia, Shari E Gelber

  • 1Institute for Genetics and Fetal Medicine, St. Luke's-Roosevelt Hospital Center, 1000 10th Avenue, Suite 11A-1, New York, NY 10019, USA. IGFM@chpnet.org

Clinics in Perinatology
|April 17, 2003
PubMed
Summary
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Multifetal pregnancy reduction (MFPR) improves outcomes for triplets or more, but its routine use in twins is debated. While MFPR enhances fetal survival, ethical considerations and varying operator experience impact results.

Area of Science:

  • Reproductive Medicine
  • Maternal-Fetal Medicine
  • Medical Ethics

Background:

  • Multifetal pregnancy reduction (MFPR) remains a controversial topic with diverse ethical viewpoints.
  • Historically, opinions on MFPR have not strictly adhered to pro-choice or pro-life stances.
  • MFPR has become an established component of infertility treatment over the last 15 years.

Purpose of the Study:

  • To analyze the evolving debate surrounding multifetal pregnancy reduction (MFPR).
  • To present current data on the risks and benefits of MFPR.
  • To discuss the appropriateness of routine MFPR for twin gestations.

Main Methods:

  • Review of historical and current data on multifetal pregnancy reduction (MFPR) outcomes.
  • Analysis of pregnancy loss rates and premature delivery risks associated with MFPR.
Keywords:
Genetics and Reproduction

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  • Examination of ethical considerations and patient counseling regarding MFPR.

    • Main Results:

    • MFPR demonstrably improves outcomes for pregnancies with triplets or more fetuses.
    • Data indicate that reducing twins to a singleton pregnancy enhances the outcome for the remaining fetus.
    • Pregnancy loss rates increase with higher starting numbers of fetuses (e.g., 4.5% for triplets, 15% for sextuplets or more).
    • Outcomes are influenced by operator experience, with less experienced practitioners reporting worse results.
    • Early premature delivery rates correlate with the starting number of fetuses, and specific finishing numbers (twins) yield better outcomes.

    Conclusions:

    • MFPR is an effective intervention for high-order multifetal pregnancies, with established risks and benefits.
    • The routine application of MFPR for twin pregnancies presents an emerging ethical debate.
    • Continued advancements in assisted reproductive technologies may eventually render MFPR obsolete.