Exceptional Circumstances: Selective Abortion

What is Selective Fetal Reduction?

• Selective abortion is the rare practice of terminating a pregnancy for some, but not all, fetuses in a multiple pregnancy.
  
• A multiple pregnancy is a pregnancy that contains more than one fetus.
  

• Selective abortions are performed because of congenital defects, or to reduce the number of babies in a pregnancy. The remaining baby(ies) is/are carried until birth unless the procedure triggers complications.

• Since most fetal defects are diagnosed well into the pregnancy, selective abortions are often late-term.

• Sex-selective abortion is another type of selective abortion. Abortions motivated by gender selection are illegal in most regions.
  
• Every country has its own regulations concerning selective abortion, as detailed below.

Perhaps your doctor has suggested a selective abortion. You may be unsure what this means and what choices you are given. Our goal is to provide you with information and counseling tools so that you can consider your options and find the path that is right for you. 💚

• ⚖️ Wondering whether to have a selective reduction or not? — Take the test
• 👩‍💻 Are you already familiar with your options and looking for direction? Take advantage of our judgement-free coaching!

Types of Selective Abortion

There are two types of selective abortion in multiple pregnancies: selective termination and selective reduction. Both describe procedures in which one or more of the fetuses are aborted, leaving at least one baby to be carried to delivery.

Selective Termination (ST)

Selective Termination (ST) is the practice of aborting one or more fetuses in a multiple pregnancy due to a birth defect diagnosis.

Some parents consider selective termination due to the diagnosis of severe, progressive twin-to-twin transfusion syndrome (TTTS).

Note: 90% of pregnancies treated for TTTS lead to two healthy babies. If your doctor suggests selective termination, you have the right to seek a second opinion.

Raising a Child with Disabilities

• On average, 1 in 20 twin prenatal screenings indicate an increased chance of fetal defects.
• Frequently, the gravity of this medical concern is exaggerated, as the impact of the diagnosis is less severe than anticipated — or the results even turn out to be a false positive.

🤰 Your prenatal screening may have raised some red flags. Now you are wondering where to go from here.

📘 Further reading:

• Birth Defect Diagnosis — Now What?

⁉️ Wondering whether to have a selective termination? Take the Test!

Selective Reduction (SR)

Selective reduction, aka multifetal pregnancy reduction (MFPR) or selective fetal reduction, is the practice of aborting one or more fetuses in a multiple pregnancy to reduce the number of babies carried at one time.

Medical professionals sometimes suggest a selective reduction in cases of big multiple births of quadruplets or more. Concerns center on the survival rate of big multiples and on the ability of the parents to cope.

• The chance of conceiving multiples is 11 times greater in couples undergoing fertility treatment than in the general population. Often more fetuses are implanted than desired to increase the likelihood of a live birth.
  
• Before IVF, doctors often ask patients for permission to reduce the number of fetuses later, should several babies “catch.” Patients eagerly agree, feeling that the prospect of having a baby is increased through a greater number of implanted embryos. Then they face a moral dilemma when several babies start developing...

ℹ️ Even if you had a reduction agreement with your fertility specialist beforehand, no doctor can force you to have a selective abortion. It is your choice.

👩‍👧‍👦 You had hoped for one baby and now you are expecting multiples? This would be a surprising turn of events, probably making you feel as if a rug had been pulled from under your feet. Are you wondering whether you could handle more than one baby?

Or you may be looking for an obstetrician who welcomes the idea of large multiples?

Whatever your concern, we are glad to walk alongside you!

📘 Further Reading:

• Twin Pregnancy: How Will I Manage?
• Pregnant and Overwhelmed
• Surprise Pregnancy with Baby Number 2, 3, 4, 5...

Timing

Selective Terminations

Selective terminations are most frequently performed within the second trimester after prenatal screenings have revealed congenital defects. Often the baby in question is already viable outside the womb.

• Selective terminations are usually late-term abortions.

Most regions have laws stipulating that late-term abortions, including selective terminations, must be warranted by an approved indicator, such as health of the mother or severe genetic disorder which is incompatible with life. While selective abortions are a legal gray in some US states, it is safe to assume that selective terminations are highly restricted in states where abortion is banned or limited.

Selective Reductions

High-order multiple pregnancies (triplets or more) might raise the question of selective reduction early on.

• Selective reductions are usually carried out between the 11th and 14th week of pregnancy.

️️ℹ️ For moral reasons, very few doctors are willing to reduce twins to singletons without medical cause. The risk to the life of the remaining child is also considered.

🩺 Thinking about a fetal defect abortion? Take the Fetal Defect Abortion Test!

Emotional Turmoil

The most vulnerable trimester has passed, and nesting is well underway. Day by day, the emotional bonds between mother and child become stronger.

All the information currently being provided would be hard to digest. Most people freeze — which is understandable considering the immense emotional strain this situation would trigger.

ℹ️ You are not alone! Support is available for your specific situation:

• If you are pregnant now: Center for Loss in Multiple Birth (CLIMB) (10.01.2022).
• Difficult decisions: When Selective Reduction is on the Table: Twinfo (10.01.2022).
• TTTS (Twin to Twin Transfusion Syndrome) grief support group: Facebook (05.01.2022).

Selective Abortion Procedures

The type of procedure depends on the timing of the abortion, whether a specific baby is chosen for termination, and whether the twins are monochorionic (share the same placenta).

Vacuum Aspiration

Early reductions can sometimes be completed through ultrasound-guided vacuum aspiration.

• The selection is completely arbitrary. This procedure is done for reduction at random.
  
• This method poses a greater risk of pregnancy loss compared to all other procedures.

Feticide

Seventy-five percent of selective abortions are performed in the second trimester using feticidal injection (KCl). The procedure usually takes place over a two-day period:

• Day 1: The physician uses ultrasound to identify the child to be aborted. When no abnormalities are present, the choice is affected by size and ease of access.
  
• Day 2: A needle is inserted through the belly into the uterus. Using ultrasound as a guide, the feticide is injected into the umbilical cord or directly into the heart. This stops the baby’s heartbeat.
  
• The dead child remains in the uterus, where it is either absorbed or expelled at the birth of the remaining baby(ies). The aborted baby is not surgically removed, as this would increase the risk of miscarriage.

️⚠️ Since giving an injection into the uterus is an invasive procedure, it poses the risk of triggering a miscarriage. It is possible for the lives of the desired babies to be lost alongside the other(s).

Other Selective Abortion Procedures

In monochorionic twins (sharing a placenta), using KCl is not possible. When TTTS is threatening to demand the life of both babies, radiofrequency ablation (RFA), bipolar cord coagulation (BCC), or interstitial laser ablation (ILA) are used for selective terminations.

Selective Abortion Near Me

Selective abortion is handled differently in each region. Find out about selective abortion regulations and practices in your country by referring to the list of regulations below.

Seek Counseling!

You may feel like you are drowning in a quagmire of concerns and questions while trying to figure out whether to have a selective abortion or not. Despite the initial shock, you may desire to know more about this diagnosis of fetal defect or multiple pregnancy. You are probably looking for answers to the following questions:

• Would it be possible for me to manage with so many babies or with a disabled child? Could I do it?
• How do I decide which child is to live or not? Should I be the one to choose?
• What about the surviving sibling — will it realize what has happened?
• How would I cope if this decision led to a miscarriage and all the babies died?

You have the right to receive medical support and have the option of seeking a second opinion.

➡️ You may sense that abortion is not right for you, but you feel completely overwhelmed at the prospect of raising multiples, perhaps even with disabilities. Financial and practical support is available. For more information, go to Support for Twin Moms.

If this subject concerns you directly, we would like to be there for you. Make use of our free resources! Allow us to be your neutral sounding board, helping you discover a path that you can feel good about in the long run.

• ⛑ Unsure where to start? Take the First Aid Test

• 🧔🏻‍♂️ How do I react if he does not want the baby?

• 🤱 Pregnant again after a C-section: Is it too soon?

• 🛤 Could an abortion affect me long term?

• Overview of free counseling services

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Disclaimer:

While Profemina aims to provide you with the most up-to-date information possible, we cannot guarantee the accuracy of the regulations and statistics listed in this article.