The Pros and Cons of Multi-Fetal Pregnancy Reduction
By Rochelle Caviness
Pregnancies, in which high order multiple gestations occur, tend to have a high incidence of complications. These complications include the increased risk of a miscarriage, premature delivery, impaired fetal development, birth defects, and cord entanglement. Multiple gestations also increase the risk that the mother will develop complications such preeclampsia, diabetes, or that she will suffer from postpartum hemorrhages.
High order multiple gestations are defined as pregnancies in which three or more fetuses are present.
Ethical Issues
Multiple gestations often occur due to the use of fertility drugs or other infertility techniques such as in vitro fertilization. Before the advent of such techniques, the chances of having anything more than twins were extremely rare. In normal circumstances, twins or triplets occur in about 1% of all pregnancies. However, with the use of infertility treatments, the chances of multiple fetuses developing increases to 30%. This in turn opens a range of ethical considerations which should be taken into account even before any infertility treatments begin, such as how you will handle a multiple gestation pregnancy, if it should occur.
Modern Medicine
While modern medical techniques have increased the occurrence of high order multiple gestations, these techniques have also increased the likelihood that some, if not all, of the fetus will be born alive. Despite advances, multiples are still likely to be born prematurely and underweight.
These advances have not eliminated the risk of congenital birth defects or developmental retardation caused by multiple gestations.
As well, they are unable to ensure the long-term survival of such infants. Many of those that do survive require long term, and costly medical care.
Despite these advances, multiple gestations still place both the mother and the fetuses at an increased risk of suffering death or severe injury.
Pregnancy Reduction
Modern medical techniques may be the main cause of high order multiple gestations, but modern medicine also offers an option to decrease these risks. This technique is called Pregnancy Reduction and involves selectively aborting one or more of the fetuses, leaving one or two to grow to maturity.
In cases of twins or triplets, pregnancy reduction is seldom recommended. In most circumstances, pregnancy reduction is only recommended when four or more fetuses are present.
Pregnancy Reduction is usually performed sometime between the 9th and 16th week of the pregnancy, although it can be performed as late as the 24th week. However, the earlier it is performed, the greater the chances of success and the fewer complications.
Complications of Pregnancy Reduction
Before deciding to have a pregnancy reduction performed, it is vital that you also understand the risks.
In about 5% of all cases, the reduction will induce a miscarriage, resulting in the loss of all the fetuses.
While extremely rare, there is a chance that the mother will develop an infection from the procedure.
Another complication that is often overlooked its psychological impact. Pregnancy Reduction can be traumatic, causing the woman to suffer from guilt and to grieve for the lost fetuses, much as they would if a miscarriage had occurred. This can be further complicated if the reduction results in the miscarriage of all the fetuses.
Before undergoing a reduction, it is wise for both parties involved to speak with a counselor or to seek spiritual guidance. Joining a support group can also provide additional comfort.
Benefits of Pregnancy Reduction
Most pregnancy reductions reduce the number of fetuses to two. This gives the remaining fetuses a better chance of surviving and being born healthy. Other benefits include:
Shorter hospital stays because the surviving babies tend to be born nearer to term and have a higher birth weight.
Decreased risk of a miscarriage. For example, in one study reported by Y. Yaron, the risk of a miscarriage with triplets was 25%, when the pregnancy was reduced to twins, the risk of a miscarriage dropped to 6.2%.
Mother's of high order multiples that undergo pregnancy reduction tend to be healthier throughout their pregnancies. They also recover faster from the birth and they suffer fewer complications.
Reduction decreases the likelihood that a caesarian section will be needed.
The decision to undergo a pregnancy reduction is not an easy decision to make. However, with proper counseling and careful study of the medical issues involved, you will be able to make an informed decision as to whether this procedure is right for you.
