Selective Fetal Reduction

Selective fetal reduction is a procedure which allows reduction of viability of a multifetal pregnancy to a lower order pregnancy. For example, triplets could be reduced to twins. Multiple gestations of triplets or more have a significant increase in perinatal morbidity and mortality compared with twins. On average, triplet gestations deliver at approximately 33.5 weeks. Approximately 25% deliver at < 32 weeks and 10% deliver < 28 weeks. Maternal complications are also significantly increased. Multifetal pregnancy reduction involves the ultrasonically guided injection of KCl into the fetal thorax to induce asystole. It is performed to reduce the potential for early preterm delivery associated with higher-order multiple gestations. Multifetal pregnancy reduction to twins increases gestational age at delivery by 4 weeks and significantly improves maternal and fetal outcomes.

In some cases, there may be twins with one fetus having a serious anomaly which can affect the other healthy co -twin. In these cases, an appropriately timed and executed fetal reduction procedure can optimise the prospects for the healthy co twin. These procedures require precision and judgement of risk factors and are associated with possible adverse outcomes in few cases like complete miscarriage of the pregnancy. It is thus imperative that these procedures are undertaken with all precautions, by an experienced operator and with due consideration of all other alternatives.