The Changing Face of Feticide in Multiple Pregnancies

The selective termination of one or more fetuses in higher order multiple pregnancies began in the 1980s in response to the increased rate of multiples arising from assisted reproductive technology (ART). Multifetal Pregnancy Reduction (MFPR) was justified by improving outcomes for the remaining offspring and their mother, and while the evidence suggests prematurity and the morbidity associated with it are reduced, there is a cost in increased miscarriage and mortality. As perinatal care has advanced, the margins of improvement have narrowed and hence the cost/benefit ratio. At the same time, MFPR has morphed from a rare procedure undertaken for quadruplets and higher, to one in which triplets and twins are increasingly reduced to a singleton, and more so for social reasons. This review considers the evidence for MFPR's efficacy and risks, along with those changes over time. Notably absent is research on the surviving children or the ongoing physical and mental health of mothers. The ethical reasoning used by practitioners and others is also explored, as is the culture of ART and abortion that drive the practice.