First-trimester multifetal pregnancy reduction: acute and persistent psychologic reactions

Area of Science:

• Perinatal Psychology
• Reproductive Medicine

Background:

• Multifetal pregnancy reduction (MFP) is a procedure to reduce the number of fetuses in a multiple gestation.
• This intervention is often necessary to improve the viability of remaining fetuses and reduce maternal complications.
• The psychological impact of selective fetal termination on maternal well-being is a critical area of study.

Purpose of the Study:

• To determine the acute and persistent psychological effects of multifetal pregnancy reductions.
• To assess patients' coping mechanisms following fetal loss.
• To understand the process of maternal bonding with surviving infants after selective reduction.

Main Methods:

• A retrospective telephone study was conducted with the first 100 women undergoing multifetal pregnancy reduction.
• A semistructured interview collected demographic and obstetric data.
• Standardized scales assessed repetitive thoughts, fears, and depressive feelings related to fetal loss.

Main Results:

• Over 65% reported acute emotional pain, stress, and fear during the procedure.
• 70% experienced mourning for lost fetuses, typically resolving within one month.
• Persistent depressive symptoms were generally mild, but sadness and guilt continued for some.
• 93% of women would opt for the same procedure again.

Conclusions:

• Multifetal reductions are psychologically stressful but generally well-tolerated.
• While most women successfully resolve grief, a subgroup may experience persistent sadness and guilt.
• Successful maternal bonding and achieving parenthood goals aid in grief resolution.
• The majority of women reconcile the termination of some fetuses to preserve the lives of others.