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Risks and complications of IVF treatment

Outlines the main treatment options available to couples if multiple pregnancy is diagnosed.

What are the options available to a couple if an ultrasound scan diagnoses a high order of multiple pregnancy?

There several strategies that can be adopted if an early pregnancy scan diagnoses a high order multiple pregnancy. These include taking a 'wait and see' approach, elective fetal reduction and termination of pregnancy.

Wait and see

In about 10-30% of multiple pregnancies, one or more fetus will be spontaneously absorbed “vanished fetus”. This usually occurs before 12 weeks of pregnancy. The rate of vanishing fetuses rises with increasing woman’s age.

Elective fetal reduction

Multifetal reduction is a technique that reduces the number of fetuses. It can be used to convert a triplet pregnancy to a twin or singleton pregnancy, thereby increasing the likelihood that the remaining pregnancy will continue and avoiding the trauma of aborting a wanted pregnancy. The procedure is usually performed when there are three fetuses or more. The number of fetuses is usually reduced to two, but sometimes to one. Fetal reduction is usually done between 10-12 weeks of pregnancy, but is has been performed up to 24 weeks. The procedure is usually performed by ultrasound guided injection of potassium chloride into the fetal heart, this will cause death of the fetus. Fetuses further away from the cervix and/or with suspicious ultrasound features of chromosomal abnormalities are terminated. The dead fetus is then absorbed by the body, while the others continue to grow.

Elective fetal reduction creates a number of ethical and medical concerns. Multifetal reduction does not restore the risks of obstetrics complications to the levels usually expected in single pregnancy. Preterm labor occurs in about 75% of multifetal pregnancy reduction pregnancies. Miscarriage of the remaining fetuses occurs in about 10% of cases and maternal infection rarely occur.

Termination of pregnancy

Occasionally couple may opt for termination of the pregnancy as a last resort.

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