title: Selective reduction of multifetal pregnancies.
abstract: Selective reduction was carried out in 46 multifetal pregnancies by means of potassium chloride injection into the pericardial region of the fetus. There were three indications for the procedure: to improve perinatal outcome and to increase the likelihood that a term infant would be born in a multifetal pregnancy (34 women); to allow the birth of a healthy infant without the birth of a congenitally abnormal coexisting fetus (8 women); and to preserve a singleton pregnancy when the woman would otherwise have the whole pregnancy terminated (4 women). Of the 80 fetuses left after reduction 75 (94%) have survived. In 3 cases ultrasound scanning showed cardiac activity in the injected fetus 20-30 min after the initial injection despite 2 min of asystole immediately after the injection; repeated injection, carried out the same day, led to fetal death in all 3 cases. Selective reduction of multifetal pregnancies for the three indications described is an ethically justifiable option for the management of multifetal pregnancy, to which there are no public policy obstacles.
authors.affiliation: Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: R J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: G H
authors.initials: GH
authors.lastname: Davis
authors.forename: A
authors.initials: A
authors.lastname: Johnson
authors.forename: V J
authors.initials: VJ
authors.lastname: Weinblatt
authors.forename: R L
authors.initials: RL
authors.lastname: Fischer
authors.forename: L G
authors.initials: LG
authors.lastname: Jackson
authors.forename: F A
authors.initials: FA
authors.lastname: Chervenak
authors.forename: L B
authors.initials: LB
authors.lastname: McCullough
mesh_terms: D000013:Congenital Abnormalities / Q000175:diagnosis; D004992:Ethics, Medical; D005069:Evaluation Studies as Topic; D005260:Female; D005313:Fetal Death / Q000139:chemically induced*; D005315:Fetal Diseases / Q000175:diagnosis; D005318:Fetal Heart / Q000187:drug effects*; D005865:Gestational Age; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D007267:Injections; D010344:Patient Advocacy; D011189:Potassium Chloride / Q000008:administration & dosage*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D014463:Ultrasonography; D014481:United States
chemical_list: D011189:Potassium Chloride