Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

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Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

Get the facts

Your options

  • Carry a pregnancy with three or more fetuses.
  • Have multifetal pregnancy reduction. This procedure reduces the
    number of fetuses.

This information is for women who are pregnant with three
or more fetuses. It's also for their partners.

Key points to remember

  • Having fewer fetuses lowers all risks. This makes it more
    likely that you will have a healthy pregnancy and a healthy baby or
    babies.
  • The risk of premature birth is higher when you are carrying multiple fetuses, which increases an
    infant's chances of having severe health problems.
  • This procedure to reduce the number of fetuses has a risk of
    miscarriage of the remaining fetuses.
  • Early genetic testing (chorionic villus sampling) and
    fetal ultrasound can help you find out if any of the
    fetuses has a problem. This information may help you decide about reducing the
    number of fetuses.
  • This decision may be emotional and complex. For some people,
    it raises ethical and spiritual concerns.
FAQs

What is multifetal pregnancy reduction?

Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a
pregnancy—usually from three, four, or five fetuses to two. This may help the
two fetuses survive and help you have a healthy pregnancy.

This
procedure is most often done early in a pregnancy, between the 9th and 12th
weeks. It's often done after genetic testing to find out if the fetuses have
any problems.

It's usually done through the belly. Using
ultrasound as a guide, the doctor puts a needle into
the uterus to the selected fetus or the
umbilical cord. The doctor injects the fetus or the
cord with a medicine that stops the heart.

Sometimes vaginal
bleeding happens afterward. This is normal.

The dead
embryo or fetus is absorbed by the mother's body. This
is similar to what happens with
vanishing twin syndrome.

What are the benefits of a multifetal pregnancy reduction?

Reduced risk for mother. The procedure
reduces the mother's risk of problems. These risks include
gestational diabetes,
preeclampsia, and
anemia. These risks increase with each added
fetus.

Reduced risk for infants. The procedure may improve your chances of carrying your pregnancy longer and your chances of delivering one or more healthy babies.

Carrying triplets or more increases the risk
of miscarriage, stillbirth, premature birth, and disability.

Reduced stress related to infant care.
Caring for three or more babies can be stressful, especially if any of them has
health problems.

Reduced cost of caring for multiples. The hospital care for three or more infants can be expensive.
Because multiple babies have an increased chance of premature birth and
illnesses, they are cared for in a neonatal intensive care unit (NICU). Caring
for the babies at home also could be costly. After they come home, premature
babies often need medicines, medical equipment and supplies, and extra doctor
visits.

What are the risks of multifetal pregnancy reduction?

The risks of reducing the number of fetuses include:

  • Miscarriage of the
    other fetuses. About 4 out of 100 triplet-to-twin procedures and about 7 out of 100 quadruplet-to-twin procedures lead to
    miscarriage. This means
    that 96 out of 100 triplet-to-twin procedures and 93 out of 100 quadruplet-to-twin procedures don't cause a miscarriage.footnote 1 The miscarriage rate is highest when reducing from 6 or more fetuses. The miscarriage rate is lower if there are fewer fetuses at the start of the procedure.footnote 1
  • Emotional risks for you, especially if
    the pregnancy miscarries. Some parents who go on to have a healthy pregnancy
    view the reduction as sad but medically needed. Others who have had a reduction
    followed by a healthy pregnancy say they felt grief, guilt, and depression
    about their decision. But for many women these feelings usually are reduced with time.footnote 2
  • Infection of the belly or uterus. This
    is rare.

Some couples choose to implant fewer embryos to reduce
the chance of a pregnancy of triplets or more, rather than consider having this
procedure.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have fetal reduction

Have fetal reduction

  • You will have an ultrasound
    test to make sure that the fetus or fetuses to be reduced are in their own
    amniotic sac. Separate sacs reduce the chance of miscarriage. A different
    procedure may be done if the fetuses are in the same sac.
  • It's done in the doctor's office. It takes only a few
    minutes.
  • You will be watched at the doctor's office afterward to
    make sure that the remaining fetuses are doing well.
  • Having fewer fetuses
    reduces the risk of miscarriage, stillbirth, premature birth, and
    disability.
  • You have a lower chance of problems in your pregnancy,
    such as
    gestational diabetes,
    preeclampsia, or
    anemia. These risks increase with each added
    fetus.
  • It may reduce the stress related to caring for more infants.
  • It reduces the cost of caring for multiple infants.
  • You could
    miscarry the remaining fetuses. When reducing from a triplet to a twin
    pregnancy, the miscarriage rate is about 4 out of 100 pregnancies. And when reducing from a quadruplet to a twin pregnancy, the miscarriage rate is about 7 out of 100. This means that
    a miscarriage doesn't happen in 96 out of 100 triplet-to-twin procedures and in 93 out of 100 quadruplet-to-twin procedures.footnote 1 The risk of miscarriage from the procedure is highest when reducing from 6 or more fetuses. The risk of miscarriage is lower if there are fewer fetuses at the start of the procedure.footnote 1
  • You could have an infection in your belly or uterus. This is
    rare.
  • Some parents have grief, guilt, and depression about
    reducing the number of fetuses. But these feelings may decrease with time.footnote 2
Carry three or more
fetuses

Carry three or more
fetuses

  • You will see your
    doctor more often during your pregnancy.
  • You will likely see a
    perinatologist. This doctor takes care of women who
    may have a problem in their pregnancy.
  • You may have more tests than
    you would in a pregnancy with one fetus.
  • You may avoid the emotional stress that some people feel about reducing the number of fetuses.
  • You have a lower risk of infection.
  • Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.
  • Multiple pregnancy increases the mother's risk of problems such
    as gestational diabetes, preeclampsia, and anemia. These risks increase with
    each added fetus.

Personal stories about multifetal pregnancy reduction

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When my
husband and I learned we were expecting three babies, we were thrilled.
But along with that news we heard about the risks for them and me. I'm
already at risk for pregnancy problems, since I've had gestational diabetes
before. So we decided to have a multifetal pregnancy reduction. What convinced
me was the knowledge that the miscarriage rate is higher for triplet pregnancy
than it is for the twins after the procedure. And it went well for us. We took
the risk, and the babies and I are doing well.

Pam, age 37

Because of
my age, our fertility doctor encouraged us to have four embryos transferred for
my in vitro. We were surprised that all of them took and were worried about the
risks. After talking for a few days about having a multifetal pregnancy
reduction, my husband and I decided not to have one. We were more comfortable
with letting nature take its course. And it did—by the second trimester, two
were gone, and I was carrying twins.

Maya, age 43

We knew
right away that carrying five babies was not going to work for them or me. So
I had a multifetal pregnancy reduction. Then I miscarried. Even though it
seemed like the obvious course to take, I'll never stop feeling terrible about
it.

Jenny, age
39

I just couldn't bring myself to have a
multifetal pregnancy reduction, even though my doctor told me that my pregnancy
was high-risk. I'll never know whether it would have gone better if I'd had the
procedure, but trying to carry the four babies didn't go well. One died after
birth, and now we have the challenge of raising triplets, one of which is
disabled.

Joelle, age
35

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have fetal reduction

Reasons to carry triplets or more

I want to increase the chance of having two healthy babies.

I want to try to have all my babies.

More important
Equally important
More important

I want to lower my chance of having a problem like preeclampsia.

I may not have any problems. But if I do, my doctor and I can decide about treatment then.

More important
Equally important
More important

My ethical and spiritual values would allow me to have fetal reduction.

My ethical and spiritual values wouldn't allow me to have fetal reduction.

More important
Equally important
More important

I don't think I can take care of a child with a disability.

I can take care of a child with a disability.

More important
Equally important
More important

I can't afford to raise three or more children.

I have the resources to raise several children.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Fetal reduction

Having triplets or more

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Does a fetal reduction lower the chance that your remaining baby or babies will have a disability?
2, Is your risk of having a miscarriage higher with a fetal reduction than it is with having triplets or more?
3, Do both choices have emotional side effects?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure


Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer William Gilbert, MD - Maternal and Fetal Medicine

References
Citations
  1. Malone FD, D'Alton ME (2009). Multiple gestation: Clinical characteristics and management. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 453–476. Philadelphia: Saunders Elsevier.
  2. Cunningham FG, et al. (2010). Multifetal gestation. In Williams Obstetrics, 23rd ed., pp. 859–889. New York: McGraw-Hill.
Other Works Consulted
  • American College of Obstetricians and Gynecologists (2013). Multifetal pregnancy reduction. ACOG Committee Opinion No. 553. Obstetrics and Gynecology, 121(2): 405–410.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Carry a pregnancy with three or more fetuses.
  • Have multifetal pregnancy reduction. This procedure reduces the
    number of fetuses.

This information is for women who are pregnant with three
or more fetuses. It's also for their partners.

Key points to remember

  • Having fewer fetuses lowers all risks. This makes it more
    likely that you will have a healthy pregnancy and a healthy baby or
    babies.
  • The risk of premature birth is higher when you are carrying multiple fetuses, which increases an
    infant's chances of having severe health problems.
  • This procedure to reduce the number of fetuses has a risk of
    miscarriage of the remaining fetuses.
  • Early genetic testing (chorionic villus sampling) and
    fetal ultrasound can help you find out if any of the
    fetuses has a problem. This information may help you decide about reducing the
    number of fetuses.
  • This decision may be emotional and complex. For some people,
    it raises ethical and spiritual concerns.
FAQs

What is multifetal pregnancy reduction?

Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a
pregnancy—usually from three, four, or five fetuses to two. This may help the
two fetuses survive and help you have a healthy pregnancy.

This
procedure is most often done early in a pregnancy, between the 9th and 12th
weeks. It's often done after genetic testing to find out if the fetuses have
any problems.

It's usually done through the belly. Using
ultrasound as a guide, the doctor puts a needle into
the uterus to the selected fetus or the
umbilical cord. The doctor injects the fetus or the
cord with a medicine that stops the heart.

Sometimes vaginal
bleeding happens afterward. This is normal.

The dead
embryo or fetus is absorbed by the mother's body. This
is similar to what happens with
vanishing twin syndrome.

What are the benefits of a multifetal pregnancy reduction?

Reduced risk for mother. The procedure
reduces the mother's risk of problems. These risks include
gestational diabetes,
preeclampsia, and
anemia. These risks increase with each added
fetus.

Reduced risk for infants. The procedure may improve your chances of carrying your pregnancy longer and your chances of delivering one or more healthy babies.

Carrying triplets or more increases the risk
of miscarriage, stillbirth, premature birth, and disability.

Reduced stress related to infant care.
Caring for three or more babies can be stressful, especially if any of them has
health problems.

Reduced cost of caring for multiples. The hospital care for three or more infants can be expensive.
Because multiple babies have an increased chance of premature birth and
illnesses, they are cared for in a neonatal intensive care unit (NICU). Caring
for the babies at home also could be costly. After they come home, premature
babies often need medicines, medical equipment and supplies, and extra doctor
visits.

What are the risks of multifetal pregnancy reduction?

The risks of reducing the number of fetuses include:

  • Miscarriage of the
    other fetuses. About 4 out of 100 triplet-to-twin procedures and about 7 out of 100 quadruplet-to-twin procedures lead to
    miscarriage. This means
    that 96 out of 100 triplet-to-twin procedures and 93 out of 100 quadruplet-to-twin procedures don't cause a miscarriage.1 The miscarriage rate is highest when reducing from 6 or more fetuses. The miscarriage rate is lower if there are fewer fetuses at the start of the procedure.1
  • Emotional risks for you, especially if
    the pregnancy miscarries. Some parents who go on to have a healthy pregnancy
    view the reduction as sad but medically needed. Others who have had a reduction
    followed by a healthy pregnancy say they felt grief, guilt, and depression
    about their decision. But for many women these feelings usually are reduced with time.2
  • Infection of the belly or uterus. This
    is rare.

Some couples choose to implant fewer embryos to reduce
the chance of a pregnancy of triplets or more, rather than consider having this
procedure.

2. Compare your options

  Have fetal reduction
Carry three or more
fetuses
What is usually involved?
  • You will have an ultrasound
    test to make sure that the fetus or fetuses to be reduced are in their own
    amniotic sac. Separate sacs reduce the chance of miscarriage. A different
    procedure may be done if the fetuses are in the same sac.
  • It's done in the doctor's office. It takes only a few
    minutes.
  • You will be watched at the doctor's office afterward to
    make sure that the remaining fetuses are doing well.
  • You will see your
    doctor more often during your pregnancy.
  • You will likely see a
    perinatologist. This doctor takes care of women who
    may have a problem in their pregnancy.
  • You may have more tests than
    you would in a pregnancy with one fetus.
What are the benefits?
  • Having fewer fetuses
    reduces the risk of miscarriage, stillbirth, premature birth, and
    disability.
  • You have a lower chance of problems in your pregnancy,
    such as
    gestational diabetes,
    preeclampsia, or
    anemia. These risks increase with each added
    fetus.
  • It may reduce the stress related to caring for more infants.
  • It reduces the cost of caring for multiple infants.
  • You may avoid the emotional stress that some people feel about reducing the number of fetuses.
  • You have a lower risk of infection.
What are the risks and side effects?
  • You could
    miscarry the remaining fetuses. When reducing from a triplet to a twin
    pregnancy, the miscarriage rate is about 4 out of 100 pregnancies. And when reducing from a quadruplet to a twin pregnancy, the miscarriage rate is about 7 out of 100. This means that
    a miscarriage doesn't happen in 96 out of 100 triplet-to-twin procedures and in 93 out of 100 quadruplet-to-twin procedures.1 The risk of miscarriage from the procedure is highest when reducing from 6 or more fetuses. The risk of miscarriage is lower if there are fewer fetuses at the start of the procedure.1
  • You could have an infection in your belly or uterus. This is
    rare.
  • Some parents have grief, guilt, and depression about
    reducing the number of fetuses. But these feelings may decrease with time.2
  • Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.
  • Multiple pregnancy increases the mother's risk of problems such
    as gestational diabetes, preeclampsia, and anemia. These risks increase with
    each added fetus.

Personal stories

Personal stories about multifetal pregnancy reduction

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When my husband and I learned we were expecting three babies, we were thrilled. But along with that news we heard about the risks for them and me. I'm already at risk for pregnancy problems, since I've had gestational diabetes before. So we decided to have a multifetal pregnancy reduction. What convinced me was the knowledge that the miscarriage rate is higher for triplet pregnancy than it is for the twins after the procedure. And it went well for us. We took the risk, and the babies and I are doing well."

— Pam, age 37

"Because of my age, our fertility doctor encouraged us to have four embryos transferred for my in vitro. We were surprised that all of them took and were worried about the risks. After talking for a few days about having a multifetal pregnancy reduction, my husband and I decided not to have one. We were more comfortable with letting nature take its course. And it did—by the second trimester, two were gone, and I was carrying twins."

— Maya, age 43

"We knew right away that carrying five babies was not going to work for them or me. So I had a multifetal pregnancy reduction. Then I miscarried. Even though it seemed like the obvious course to take, I'll never stop feeling terrible about it."

— Jenny, age
39

"I just couldn't bring myself to have a multifetal pregnancy reduction, even though my doctor told me that my pregnancy was high-risk. I'll never know whether it would have gone better if I'd had the procedure, but trying to carry the four babies didn't go well. One died after birth, and now we have the challenge of raising triplets, one of which is disabled."

— Joelle, age
35

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have fetal reduction

Reasons to carry triplets or more

I want to increase the chance of having two healthy babies.

I want to try to have all my babies.

             
More important
Equally important
More important

I want to lower my chance of having a problem like preeclampsia.

I may not have any problems. But if I do, my doctor and I can decide about treatment then.

             
More important
Equally important
More important

My ethical and spiritual values would allow me to have fetal reduction.

My ethical and spiritual values wouldn't allow me to have fetal reduction.

             
More important
Equally important
More important

I don't think I can take care of a child with a disability.

I can take care of a child with a disability.

             
More important
Equally important
More important

I can't afford to raise three or more children.

I have the resources to raise several children.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Fetal reduction

Having triplets or more

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Does a fetal reduction lower the chance that your remaining baby or babies will have a disability?

  • Yes
  • No

  • I'm not sure

You're right. A fetal reduction lowers the chance that your remaining baby or babies will have a disability. It also lowers the chance of a fetus or infant dying or being ill.

2.
Is your risk of having a miscarriage higher with a fetal reduction than it is with having triplets or more?

  • Yes

  • No
  • I'm not sure

You're right. The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.

3.
Do both choices have emotional side effects?

  • Yes
  • No

  • I'm not sure

You're right. Either choice can be emotional and complex. You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.

Decide what's next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 

Credits
By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer William Gilbert, MD - Maternal and Fetal Medicine

References
Citations
  1. Malone FD, D'Alton ME (2009). Multiple gestation: Clinical characteristics and management. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 453–476. Philadelphia: Saunders Elsevier.
  2. Cunningham FG, et al. (2010). Multifetal gestation. In Williams Obstetrics, 23rd ed., pp. 859–889. New York: McGraw-Hill.
Other Works Consulted
  • American College of Obstetricians and Gynecologists (2013). Multifetal pregnancy reduction. ACOG Committee Opinion No. 553. Obstetrics and Gynecology, 121(2): 405–410.

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