Multi-fetal pregnancy reduction (MFPR) to twins or singleton – medical justification and ethical slippery slope
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Arie Drugan
und
Amir Weissman
Abstract
Multi-fetal pregnancy reduction (MFPR) is an ethically acceptable procedure aimed to increase survival and well-being of the remaining fetuses from high-order multiple gestations. In most cases we offer the procedure to triplets or quadruplets and opt to preserve twins; lately, the option to maintain a single fetus was suggested. We examined the outcomes of 140 pregnancies that underwent MFPR in our center and were followed to delivery – 105 were reduced to twins and 35 to singletons. The rate of procedure-related pregnancy loss was identical (2.9%). Leaving only one fetus was associated with a higher gestational age at delivery (35.4±2.4 weeks vs. 37.7±2.1 weeks, P<0.0001), with heavier neonates (2222 g vs. 3017 g, P<0.0001) and with a reduction in the cesarean section (CS) rate (76% in twins vs. 51.4% in singletons, P=0.02). Six pregnancies reduced to twins (5.8%) ended before 32 weeks as compared to one pregnancy reduced to a singleton. We conclude that reduction of triplets to singletons is medically and ethically acceptable, after thorough counseling of patients. However, considering the pregnancy loss risk of MFPR and the relatively good outcome of twin gestations, reduction of twins to singletons is ethically acceptable only in extraordinary maternal or fetal conditions.
References
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The authors stated that there are no conflicts of interest regarding the publication of this article.
©2017 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Fetal diagnosis and therapy: a continously evolving discipline
- Highlight articles
- Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years
- Prenatal screening for microcephaly: an update after three decades
- Fetal echocardiography: reference values for the Chinese population
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- Combined screening test for trisomy 21 – is it as efficient as we believe?
- Fetal loss following invasive prenatal testing: a comparison of transabdominal chorionic villus sampling, transcervical chorionic villus sampling and amniocentesis
- Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques
- Prenatal decision-making in the second and third trimester in trisomy 21-affected pregnancies
- Role of collagen type IV in the pathogenesis of increased prenasal thickness in Down syndrome fetuses: sonographic and immunohistological findings
- Congenital diaphragmatic hernia: endotracheal fluid phospholipidic profile following tracheal occlusion in an experimental model
- Original articles
- The effect of intraumbilical fetal nutrition via a subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses
- Anti-inflammatory Elafin in human fetal membranes
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- Congress Calendar
- Congress Calendar
Artikel in diesem Heft
- Frontmatter
- Editorial
- Fetal diagnosis and therapy: a continously evolving discipline
- Highlight articles
- Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years
- Prenatal screening for microcephaly: an update after three decades
- Fetal echocardiography: reference values for the Chinese population
- Multi-fetal pregnancy reduction (MFPR) to twins or singleton – medical justification and ethical slippery slope
- Combined screening test for trisomy 21 – is it as efficient as we believe?
- Fetal loss following invasive prenatal testing: a comparison of transabdominal chorionic villus sampling, transcervical chorionic villus sampling and amniocentesis
- Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques
- Prenatal decision-making in the second and third trimester in trisomy 21-affected pregnancies
- Role of collagen type IV in the pathogenesis of increased prenasal thickness in Down syndrome fetuses: sonographic and immunohistological findings
- Congenital diaphragmatic hernia: endotracheal fluid phospholipidic profile following tracheal occlusion in an experimental model
- Original articles
- The effect of intraumbilical fetal nutrition via a subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses
- Anti-inflammatory Elafin in human fetal membranes
- Recombinant vascular endothelial growth factor 121 injection for the prevention of fetal growth restriction in a preeclampsia mouse model
- Estimation of fetal weight by ultrasonography after preterm premature rupture of membranes: comparison of different formulas
- Congress Calendar
- Congress Calendar
