Do reduced multiples do better?
Dramatic successes in infertility care have allowed millions of previously fertile women to have their own children. However, an epidemic of multiple pregnancies has resulted, with catastrophic increases in morbidity and mortality, and in the economic costs to society. Multifetal pregnancy reduction (MFPR) has been used to decrease fetal number in the late first trimester and has dramatically improved outcomes. Recent data suggest that pregnancies starting with three or four, and in some cases five fetuses, which are reduced to twins, do as well as starting with twins. Patients with triplets do better reduced to twins. Reduction to a singleton is becoming more common, particularly for women over 40. Combining MFPR with chorionic villus sampling in patients over 30 years of age has enabled couples to maximize the health of the resultant children.
Evans
Mark I
MI
Columbia University, Institute for Genetics and Fetal Medicine, New York, NY, USA. mevans@chpnet.org
Ciorica
Doina
D
Britt
David W
DW
D000022:Abortion, Spontaneous / Q000209:etiology; D000367:Age Factors; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000941:ethics / Q000379:methods*; D011261:Pregnancy Trimester, First; D011272:Pregnancy, Multiple / Q000502:physiology*; D027724:Reproductive Techniques, Assisted