Dr. Rajeeb Jena

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Invasive Procedures and Interventions

Multiple Pregnancy Fetal Reduction

What is Fetal Reduction?

Fetal reduction is a medical procedure performed in a multiple pregnancy to reduce the number of fetuses, typically for high-order multiples (triplets or more). The goal is to improve the outcome for the remaining fetuses and the mother by decreasing risks associated with multiple gestation.

Why is it done?

  • High risk of preterm birth and low birth weight in high-order multiples
  • Increased maternal complications: preeclampsia, gestational diabetes, and hemorrhage
  • Improve perinatal survival and reduce neonatal morbidity
  • When selective fetal anomalies are detected in one fetus

When is it performed?

Fetal reduction is usually performed between 10 and 13 weeks of gestation when chorionicity is confirmed and individual fetal anatomy can be visualized. Timing may vary based on clinical circumstances.

How is the procedure done?

  • Under ultrasound guidance, a needle is inserted into the gestational sac of the targeted fetus.
  • A small dose of potassium chloride or other agent is injected to stop the fetal heart
  • The procedure is quick (10–15 minutes) and performed under local anesthesia
  • The remaining fetuses are monitored for well-being and continued growth

Benefits and Risks

Benefits:

  • Reduces risk of preterm delivery and improves survival of remaining fetuses
  • Decreases maternal health complications

Risks:

  • Miscarriage of the entire pregnancy (1–5% risk)
  • Infection, bleeding, or injury to remaining fetuses
  • Emotional and psychological impact

Frequently Asked Questions (FAQs)

Is fetal reduction safe?

While it carries risks, in high-order multiples it may improve overall outcomes

Most procedures are outpatient; rest at home for 24–48 hours is recommended.

Local anesthesia minimizes pain; you may feel mild cramping afterward

Regular ultrasounds monitor fetal growth and maternal health

Discussion with your care team before the decision is crucial; once performed, it cannot be reversed.