Practices and perspectives on multifetal pregnancy reduction in triplet pregnancies: A Dutch mixed-methods study

To explore current practices and perspectives on multifetal pregnancy reduction (MFPR) in triplet pregnancies among Dutch obstetricians.

A national mixed-methods study was conducted, combining a digital survey and a focus group discussion. Eligible participants were obstetricians from Dutch tertiary centres who had performed MFPR in triplet pregnancies within the past five years. Survey data were analysed descriptively. Thematic analysis was applied to the focus group transcript to explore experiences with MFPR counselling, procedural practices, continuity of care, and aftercare.

Ten of 11 obstetricians (91 %) from all six tertiary centres performing MFPR completed the survey; seven of these respondents participated in the focus group. Survey respondents most commonly had 10-20 years of experience and reported managing five to 10 triplet pregnancies annually. Focus group analysis identified four key themes: (i) counselling: do's and don'ts; (ii) regional variation in MFPR care; (iii) managing high-risk pregnancies in a system full of barriers; and (iv) aftercare: invisible yet indispensable. Focus group participants differed in their counselling approaches, including the extent to which risks and statistics were discussed, and the availability of psychosocial support. Procedural differences were observed in the use of anaesthesia, staff communication, parental observation, partner involvement, and organisation of follow-up. Systemic challenges included limited capacity, and inconsistent and uncoordinated referral systems. Despite consensus on its importance, aftercare content and accessibility varied across centres. These findings reflect physician-reported practices and perspectives within the Dutch healthcare system.

MFPR in triplet pregnancies is practised differently across Dutch tertiary centres. These findings support consideration of a national guideline, or alignment with international standards, together with improved case registration and stronger intercentre collaboration, to promote more consistent and family-centred care. These organis ational implications arise from physician-reported practice variation within the Dutch healthcare system, and do not provide evidence on the clinical effectiveness, safety or patient-level outcomes of different MFPR practices.