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Fetal reduction: 25 years' experience.

Mark I Evans1, Stephanie Andriole, David W Britt

  • 1Comprehensive Genetics, Fetal Medicine Foundation of America, New York, N.Y., USA.

Fetal Diagnosis and Therapy
|February 15, 2014
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Summary
This summary is machine-generated.

Fetal reduction (FR) has evolved from a rare procedure to a standard infertility practice, improving outcomes for multiple pregnancies. Advanced diagnostics now guide decisions, including fetal anomalies and gender, enhancing reproductive choices.

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Area of Science:

  • Reproductive Medicine
  • Maternal-Fetal Medicine
  • Medical Genetics

Background:

  • Fetal reduction (FR) emerged in the 1980s to manage high-order multiple gestations resulting from fertility treatments.
  • Initially reserved for life-threatening situations, FR is now an integral component of infertility management.
  • The risks associated with multiple and premature births, even twins, are significantly higher than singleton pregnancies.

Observation:

  • Pre-FR fetal evaluation has advanced, enabling more informed decisions and improved pregnancy outcomes.
  • Current practices involve chorionic villus sampling (CVS) in ~85% of cases, with rapid FISH results allowing same-day FR.
  • Decision-making criteria have expanded beyond anomalies to include fetal gender preference, reflecting evolving societal norms.

Findings:

  • Sophisticated molecular analyses facilitate diagnoses in Mendelian cases prior to FR.
  • New applications, such as paternity analysis, are now feasible.
  • FR from twins to a singleton constitutes approximately 30% of current procedures.

Implications:

  • The ethical considerations of FR have broadened from 'life or death' scenarios to 'quality of life' issues.
  • Technological advancements in diagnostics and genetic analysis enhance the precision and scope of FR.
  • The increasing use of FR, particularly in twin gestations, highlights its role in optimizing pregnancy outcomes in assisted reproduction.