Reduction for Multiple Pregnancies

Overview

Reduction for multiple pregnancies, also known as selective reduction, is a medical procedure aimed at decreasing the number of fetuses in a multifetal pregnancy.

This process is often considered in cases where carrying multiple fetuses to term may pose significant health risks to the mother or the babies, such as preterm birth, low birth weight, or other complications.

The procedure involves an injection of medication to stop the heartbeat of one or more fetuses, allowing the remaining fetuses a better chance of healthy development.

While the decision to undergo selective reduction can be emotionally challenging, it is sometimes considered necessary for the overall well-being of both the mother and the unborn children.

It is crucial for families to engage in thorough consultations with healthcare providers to understand the benefits, risks, and long-term implications of this procedure.

Why is reduction in Multiple Pregnancy done?

Reduction in multiple pregnancy is important due to the significant health risks and complications associated with carrying multiple fetuses. These include a higher likelihood of preterm delivery, which can lead to long-term health issues or even life-threatening conditions for the babies.

Additionally, the mother may face increased risks such as gestational diabetes, hypertension, and other complications that can endanger her health.

By reducing the number of fetuses, selective reduction aims to enhance the chances of a healthy pregnancy and delivery for the remaining fetuses and the mother.

The procedure is primarily done to improve the outcomes for both the mother and the babies. Multiple pregnancies often result in low birth weight and developmental issues due to limited resources in the womb.

Selective reduction helps ensure that the remaining fetuses receive better nourishment and care, reducing the likelihood of complications. Moreover, in some cases, the anomaly or health issue in one of the fetuses necessitates the procedure to prevent potential risks to the others.

Families must carefully weigh these factors and work closely with their healthcare providers to make informed decisions regarding selective reduction.

How to Reduce Multiple Pregnancies?

Multiple pregnancies often arise from the use of fertility treatments such as in vitro fertilisation (IVF) and ovulation induction. To reduce the likelihood of multiple pregnancies, various strategies can be employed.

Elective Single Embryo Transfer (eSET)

 The elective single embryo transfer (eSET) process is a meticulous approach designed to lower the risk of multiple pregnancies during IVF treatments. The initial step involves rigorous evaluation and selection of the best quality embryo. Embryologists assess the embryos for morphological excellence and genetic normalcy, ensuring that the chosen embryo has the highest potential for successful implantation and development.

Once the ideal embryo is selected, it is carefully transferred into the uterus using a fine catheter. This procedure is typically performed under ultrasound guidance to ensure precise placement, enhancing the likelihood of successful implantation. The patient’s endometrial lining is also prepared to be in optimal condition to support the embryo.

Post-transfer, patients are closely monitored through blood tests and ultrasounds to track the progress of implantation and early pregnancy development. By adopting eSET, the chances of achieving a healthy singleton pregnancy are maximised, thereby reducing the health risks associated with multiple pregnancies.

Surgery to Reduce Multifetal Pregnancy

In cases where multifetal pregnancy occurs despite preventive measures, selective reduction surgery may be considered to mitigate the associated risks.

This surgical procedure is typically conducted during the first trimester and aims to reduce the number of fetuses in a multifetal pregnancy, thereby enhancing the chances of a healthier outcome for both the mother and the remaining fetus or fetuses.

The procedure involves the use of ultrasound guidance to accurately identify and assess each fetus. Once the decision is made regarding which fetus or fetuses will be reduced, a fine needle is inserted through the abdominal wall and into the uterus to inject a solution that stops the heart of the selected fetus.

This allows the remaining fetus or fetuses to have more space and resources, significantly reducing the risks of preterm birth and other complications commonly associated with multiple pregnancies.

Selective reduction is a complex and emotionally challenging decision for prospective parents. It requires thorough counselling and support from healthcare professionals to ensure the parents are fully informed about the procedure, its risks, and its implications.

While it is a difficult choice, selective reduction surgery can be a vital option in managing multifetal pregnancies to increase the likelihood of a healthy and successful pregnancy outcome.

Ethical Considerations

The ethical considerations surrounding reduction for multiple pregnancies are complex and often polarising.

One of the primary ethical debates centres on the moral status of the fetuses—whether it is justifiable to choose the reduction of one or more for the potential benefit of the others. Some argue that selective reduction is a form of taking life, while others view it as a necessary intervention to optimise the chances of survival and health for the remaining fetuses.

Additionally, the decision-making process can be influenced by cultural, religious, and personal values, making it essential for each family to navigate these ethical waters in a manner aligned with their beliefs.

In many cases, bioethicists and counsellors are involved in these discussions to provide guidance and support, ensuring that families make informed and considered decisions that reflect their moral viewpoints.

About Doctor

Dr. Supriya Puranik

Gynaecologist & IVF Specialist

Often known as the last glimmer of hope for people who have lost all hope for conceiving a child, Dr. Supriya Puranik is a leading gynaecologist, high-risk obstetrician and Head of IVF & Gynaecology department at Sahyadri Hospitals Momstory in Shivajinagar, Pune.

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