Selective first-trimester termination in octuplet and quadruplet pregnancies: clinical and ethical issues

The induction of grand multiple gestations is a known complication of infertility treatments. The obstetric outcome in such cases has been very poor. We have evaluated, counseled, and performed first-trimester selective terminations for four patients, all treated with human menopausal gonadotropin, one with octuplets and three with quadruplets. In all cases, the gestations were reduced to twins. In two of the four cases, the pregnancy continued to near term without problem and resulted in the delivery of healthy twins. In the third case, pregnancy continued without problems for eight weeks, at which time renal agenesis was identified in one of the twins. In the fourth case, preterm labor five weeks later could not be stopped. Significant ethical issues must be addressed. We argue that selective termination in appropriate circumstances (eg, when the ability to carry the pregnancy to viability is very small) is ethically justified because it meets the criterion of least harm and most potential good.