Selective reduction of fetuses in multiple pregnancies and. It might be a very depressing subject for the intended parents to discuss, however, in long term perspective, mfpr can lead to a healthier pregnancy. Multifetal pregnancy reduction mfpr is the medical procedure that reduces the number of fetuses carried during the multiple pregnancy. It is associated with increased maternal morbidity eg, hypertension, diabetes, and operative delivery. Multifetal pregnancy reduction is one option for women with a higherorder multiple pregnancy. The netherlands has been showing a consistent trend in reducing teen pregnancies to rates that are among the lowest in the world. Multifetal pregnancy reduction mfpr is a procedure that reduces higherorder pregnancies, which improves perinatal outcomes. Multifetal pregnancy reduction in pregnancies with a. Multifetal pregnancy and selective reduction by dr john i fleming the birth of septuplets to american couple bobbi and kenny mccaughey has attracted significant worldwide media attention1.
It is performed to reduce the potential for early preterm delivery associated with higherorder multiple gestations. Accelerating progress toward the reduction of adolescent pregnancy. Both the groups also had similar mean birth weight and take home baby rates. Pregnancy outcome of early multifetal pregnancy reduction. Guides through decision to have a multifetal pregnancy reduction. Multifetal reduction may decrease the risk of preeclampsia in women with higherorder multifetal gestations. Stillbirth 30% higher rate for children born to women under 20. One study reported that only 14% of 59 women with twin pregnancies remaining after multifetal reduction developed preeclampsia compared with 30% of women with triplet pregnancies 27. Steve lichtenberg md, mph medical director assistant professor 5,6.
Multifetal pregnancy reduction mpr is a technique developed over the past 15 years to deal with the sequelae of higher order multiple gestations resulting from infertility treatment. Fetal reduction in multifetal pregnancies associated with. Multifetal pregnancy reduction and selective termination. May 31, 2001 results for multifetal pregnancy reduction 1 10 of 19 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. It lessens maternal morbidity and fetal mortality by reducing the number. Higherorder multiple pregnancy is associated with significant maternal and fetal complications. This procedure is most often done early in a pregnancy, between the 9th and 12th weeks.
Multifetal pregnancy reduction in triplet and higherorder multiple pregnancies significantly reduces the risks of prematurity and a low birth weight, and may also be associated with a reduction in overall pregnancy loss. If a couple or individual is thinking about or has decided to proceed with multifetal reduction, a thorough ultrasound is done to check each fetus for. It is a therapeutic intervention in which potassium chloride is injected under ultrasonic guidance in to thoracic cage of selected cofetus es. Multifetal pregnancy reduction and selective termination maureen paul md, mph chief medical officer associate clinical professor 3,4, e. Multifetal pregnancy reduction of triplets to twins compared. Pregnancy outcome after multifetal pregnancy reduction article pdf available in journal of maternalfetal and neonatal medicine 161. To address these problems multifetal pregnancy reduction mfpr was developed with the aim to improve the poor prognosis of pregnancies with three or more fetuses. Fetal reduction allows the interruption of the development of one or more probably normal fetuses in a multiple pregnancy.
Interventions are proposed across the sectors of health, education, protection, gender and empowerment. Multifetal pregnancy reduction definition of multifetal. The reduction to twin pregnancies occurred between the 9th and 11th weeks of amenorrhoea, although it has since been shown that selective multifetal pregnancy reduction even at a later stage around the 20th week is associated with a favourable perinatal outcome hartoov et al. Mar 09, 2016 international, collaborative experience of 1789 patients having multifetal pregnancy reduction. Effect of selective secondtrimester multifetal pregnancy reduction. Multifetal pregnancy reduction results in pregnancy complications, gestational age, and birth weights closer to those of nonreduced twins than to expectantly managed triplets. Multifetal pregnancy reduction involves the ultrasonically guided injection of kcl into the fetal thorax to induce asystole. Multifetal pregnancy reduction in pregnancies with a monochorionic component we conducted a retrospective, crosssectional study to evaluate the ef. Multifetal pregnancy reduction of triplets to twins is associated with a better pregnancy outcome compared with that of nonreduced triplets. As a result, the united states needs a number of initiatives to reduce its teenage pregnancy rate and. Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a pregnancyusually from three, four, or five fetuses to two.
Multifetal pregnancy reduction is defined as a firsttrimester or early secondtrimester procedure for reducing the total number of fetuses in a multifetal pregnancy by one or more 1. Multifetal reduction is an elective medical procedure. We would like to show you a description here but the site wont allow us. Various aspects of multifetal pregnancy reduction are discussed, including the background, options, risks, benefits, techniques, results, and appropriate physical and psychosocial support. Discusses comparisons between twins after fetal reduction versus triplets no fetal reduction. Conclusion references out of 86 cases of multiple pregnancy who underwent selective fetal reduction 80 were confirmed their pregnancy outcomes and 6 were lost for follow up. Selective reduction is used when a mother is carrying an unsafe or undesirable number of fetuses in a multiple pregnancy, which are common in medicallyassisted pregnancies, in order to reduce the number of fetuses to a number that is relatively safe for the mother and the remaining fetuses. Reducing early and unintended pregnancies among adolescents. It is performed early in pregnancy after the diagnosis of a multiple gestation.
Practice bulletin, number 169, october 2016, multifetal. Multifetal pregnancy reduction journal of obstetric. Evolving trends in 200 cases of multifetal pregnancy reduction. Multifetal pregnancy reduction mfpr is a procedure used to reduce the number of fetuses in a multiple pregnancy, usually to two. Multifetal pregnancy reduction to twins increases gestational age at delivery by 4 weeks and significantly improves maternal and fetal. The authors shown below used federal funds provided by the u. In the management of complex medical cases such as a multifetal pregnancy, knowledge of the ethical and legal implications is important, alongside having competent medical skills. A multifetal pregnancy is an undesired outcome of assisted reproductive technology art.
Perinatal outcome after fetal reduction from twin to. A surgery called multifetal reduction lowers the number of fetuses and improves your chances for a healthy pregnancy. Multifetal gestations are at higher risk for a variety of maternal, fetal, and neonatal complications than singleton pregnancies. Ideally, multiple gestations should be prevented by better use of assisted reproductive technology eg, better management of ovulation induction and embryo transfer. Adolescent pregnancy and childbearing are common in kenya. Monochorionicity can complicate the reduction procedure. Create understanding and support to reduce pregnancy before. Pdf pregnancy outcome after multifetal pregnancy reduction. Feb 20, 2008 pregnancy outcomes according to the different methods of multifetal pregnancy reduction fetal and maternal complications, such as fetal growth restrictions, discordant twins, congenital anomalies, gestational hypertension, and cervical incompetence were not different between kcl and nonkcl groups or between early and late groups. Also called fetal reduction or selective pregnancy reduction, its a safe. Information and translations of pregnancy reduction, multifetal in the most comprehensive dictionary definitions resource on the web. Multifetal pregnancies increase perinatal morbidity and mortality.
The method used was transabdominal intracardiac injection. Evolving trends in 2,000 cases of multifetal pregnancy reduction. Efficacy of transabdominal multifetal pregnancy reduction. Multifetal pregnancy reduction evidence search nice.
The strategy spans from 20 to 2015 and sectoral adopts a multiapproach addressing teenage pregnancy in a holistic manner. When a pregnancy involves three or more fetuses highorder pregnancy, the risks of miscarriage, stillbirth, and lifelong disability increase with each additional fetus. Pregnant women and women with children experience even greater stigma. This may help the two fetuses survive and help you have a healthy pregnancy. Where fertility treatments result in highrisk, multifetal pregnancies, the pregnant woman and her partner will be presented with the option to selectively reduce the pregnancy, that is to remove one or more of the fetuses in order to create the best chance of a healthy, complicationfree pregnancy. Multifetal pregnancy reduction global fertility solutions blog. Managing riskto mother and fetusesin a twin gestation. Throughout the document, multifetal pregnancy reduction is used. Should primary prevention strategies for high order multiple pregnancies fail, multifetal pregnancy reduction may be the appropriate alternative to reduce perinatal morbidity and mortality in trichorionic. Department of justice and prepared the following final report. The birth of so many babies at one time, all of them seemingly in good physical condition is, to say the least, a highly unusual event. Accelerating progress toward the reduction of adolescent pregnancy in latin america and the. Preventing early pregnancy world health organization. Sep 22, 2017 multifetal pregnancy increases maternal, fetal and neonatal complications, most important being preterm delivery and complications of prematurity.
Fetal reduction is a procedure for reducing the number of fetuses to a more manageable number. The national strategy for the reduction of teenage pregnancy adopts a multisectoral approach, mobilizing all concerned partners and engaging all sectors of the population in a nationwide effort to target adolescents and young people. Nov 17, 2012 multifetal pregnancy reduction is one type of loss that is nearly impossible to share with others let alone have them fully understand the anxiety and dilemma that has been faced. Reduction of triplet or higher order pregnancy is acceptable and the ending number is usually two. Pregnancy outcomes of different methods for multifetal. Incidence of low birth weight of term babies 30% higher rate for babies born to women under 20. Reduction of multifetal pregnancies to twins does not. Twin, triplet, and higherorder multifetal pregnancies this practice bulletin was developed by the committee on practice bulletinsobstetrics and the society for maternalfetal medicine with the assistance of edward j. Ethical considerations for the reduction of multifetal pregnancies. The cause and effect of teenage pregnancy in this local government is not as high as it used to be because of socialization and modernization and many of those girls who held strictly to islamic injuction have now know the importance of formal education.
Neda razaz, lead author of the study, noted that the fetal reduction associated decrease in preterm birth and low birth weight overall, combined with the decrease in death and serious illness. Fetal reduction reduces the risk of preterm delivery. Application of legal principles and medical ethics. In may 20, the national strategy for the reduction of teenage pregnancy was launched. In multifetal pregnancy reduction, the fetus es to be reduced are chosen on the basis of technical considerations, such as which is most accessible to intervention and chorionicity. Study links fetal reduction in multifetal pregnancies, better.
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