Multifetal Pregnancy Reduction and Selective Termination: The Canadian Experience

Abstract

Objective: To describe the experience of two Canadian referral centres with multifetal pregnancy reduction (MFPR) and selective termination (ST). Methods: Retrospective chart review of all MFPR and ST procedures during the periods from January 1, 1990, to December 31, 1997 (Vancouver), and from September 1, 1995, to December 31, 1997 (Toronto). Outstanding outcome data were obtained by telephone. All women were managed according to standard protocols. Non-parametric analysis of continuous variables and Fisher’s exact test for categorical variables were used. Results: 61 women underwent transabdominal MFPR (n = 44) or ST (n = 17). Median maternal age: MFPR and ST 33.0 years; gestational age at reduction: MFPR 11.4, ST 20.2 weeks; procedure duration: MFPR 4, ST 10 min. 89% MFPR and 12% ST cases followed assisted reproduction. 7% MFPR and 18% ST pregnancies lost <24 weeks (n.s.). 97% MFPR and 83% ST non-reduced fetuses delivered alive. Median delivery gestational age: MFPR and ST 37 weeks. Conclusions: The results are similar to published series. This procedure has increased options for Canadian couples, offering the procedure ‘close to home’, reducing costs and, more importantly, the significant psychological morbidity following these procedures.

Multifetal Gestation – Maternal and Perinatal Outcome of 112 Pregnancies

“…The increased incidence of triplet, quadruplet and quintuplet pregnancies poses new and serious medical and ethical problems to parents and obstetricians. The widespread use of multifetal reduction techniques [1][2][3] stresses the importance of accurate data regarding maternal and fetal outcome of higher order multiple pregnancies. Not only the mere chance of survival, but the chance of intact survival often determines parental choices.…”

Differences between selective termination of pregnancy and fetal reduction in multiple pregnancy: a narrative review

“…In the majority of cases, for all types of articles combined, authors use various terms to address the same procedure. For example, in the articles dealing with selective termination, some authors use the term 'selective termination' (Berkowitz, 1997;Evans et al, 1999;Von Dadelszen et al, 1999) while others use 'selective feticide' (Antsaklis et al, 2001;Shalev et al, 1999;Ville, 2003). Concerning fetal reduction, authors use 'multifetal pregnancy reduction' (Antsaklis and Anastasakis, 2011), 'embryo reduction' (Bergh et al, 1999), 'fetal reduction' (Evans and Britt, 2008) or 'selective reduction' (Evans et al, 2005).…”

“…Fetal reduction allows the interruption of the development of one or more probably normal fetuses in a multiple pregnancy. It lessens maternal morbidity and fetal mortality by reducing the number of fetuses in utero to one, two or three in a high-rank multiple pregnancy (more than three fetuses) (Dumez and Oury, 1986;Mansour et al, 1999;Stone et al, 2008;Tadin et al, 2002;Von Dadelszen et al, 1999). One also speaks about socioeconomic indications when a couple confronted with a twin or triplet pregnancy wishes to give birth to only one or two children (Chervenak et al, 1992;Evans and Britt, 2008;Evans et al, 2004;Stone et al, 2007;Tadin et al, 2002).…”

Information and decision‐making process for selective termination of dichorionic pregnancies: some French obstetricians' points of view

“…Moreover, these technologies have made it possible for biomedical systems of representation to treat the fetus as a patient (Dumoulin and Valat, 2001;Wyatt, 2001). It is known as well that an increased incidence in fetal ultrasound procedures and prenatal genetic diagnoses has contributed directly to the increase in interventions performed on the fetus (Von Dadelszen et al, 1999).…”