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Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction

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Decision Point

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.

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Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

1

Get the
facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

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 can cause miscarriage of the remaining fetuses. The chance of this happening when triplets are reduced to twins is about 6 out of 100 pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of these procedures.¹
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 6 out of 100 triplet-to-twin procedures lead to miscarriage.¹ This also means that 94 out of 100 triplet-to-twin procedures don't cause a miscarriage. 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.²
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.³
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 6 out of 100 pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of these 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.⁴
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.³

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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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

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

What matters to you

Credits and References

Credits

Credits	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer	Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

References

Citations

American College of Obstetricians and Gynecologists (2007). Multifetal pregnancy reduction. ACOG Committee Opinion No. 369. Obstetrics and Gynecology, 109(6): 1511–1515.
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.
Cunningham FG, et al. (2010). Multifetal gestation. In Williams Obstetrics, 23rd ed., pp. 859–889. New York: McGraw-Hill.
American College of Obstetricians and Gynecologists (2004, reaffirmed 2010). Multiple gestation: Complicated twin, triplet, and high-order multifetal pregnancy. ACOG Practice Bulletin No. 56. Obstetrics and Gynecology, 104(4): 869–863.

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.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
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 can cause miscarriage of the remaining fetuses. The chance of this happening when triplets are reduced to twins is about 6 out of 100 pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of these procedures.¹
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 6 out of 100 triplet-to-twin procedures lead to miscarriage.¹ This also means that 94 out of 100 triplet-to-twin procedures don't cause a miscarriage. 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.²
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.³
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 6 out of 100 pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of these 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.⁴ 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.³	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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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

Credits

By	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer	Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

References

Citations

American College of Obstetricians and Gynecologists (2007). Multifetal pregnancy reduction. ACOG Committee Opinion No. 369. Obstetrics and Gynecology, 109(6): 1511–1515.
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.
Cunningham FG, et al. (2010). Multifetal gestation. In Williams Obstetrics, 23rd ed., pp. 859–889. New York: McGraw-Hill.
American College of Obstetricians and Gynecologists (2004, reaffirmed 2010). Multiple gestation: Complicated twin, triplet, and high-order multifetal pregnancy. ACOG Practice Bulletin No. 56. Obstetrics and Gynecology, 104(4): 869–863.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

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Last Revised: December 7, 2011

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

eMedicineHealth Medical Reference from Healthwise

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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