What is Selective Fetal Reduction?
- Selective abortion is the 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, to eliminate the threat of one fetus to the other(s), or to reduce the number of babies in a pregnancy.
- Sex-selective abortion is another type of selective abortion. Abortions motivated by gender selection are illegal in most regions.
- Every country has their 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 coaching tools, so that you can consider your options, and find the path that is right for you. 💚
👩💻 You are already familiar with your options, and are 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.
Selective Terminations are considered for two reasons:
1. The motivation is to save as many babies as possible. One fetus’ incompatibility with life is threatening the survival of the other fetus(es). An example of this is severe, progressive twin-to-twin transfusion syndrome (TTTS).
NOTE: A TTTS diagnosis does not automatically necessitate selective termination. 90% of pregnancies treated for TTTS lead to two healthy babies. If your doctor is suggesting selective termination, you have the right to seek a second opinion.
2. The motivation is to give birth only to healthy babies, aborting any fetuses with defects. Raising a child with disabilities has its challenges, which can seem overwhelming.
- 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. Your doctor may have mentioned the option of having a selective abortion. Having to consider this option would be devastating.
📘 Further reading:
⁉️ Wondering whether to have a selective termination? Take the Test!
Selective Reduction (SR)
Selective reduction, a.k.a. 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.
- The choice is usually random but is sometimes affected by the parents’ preference for a certain gender.
A selective reduction is sometimes suggested by medical professionals 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 later reduce the number of fetuses, 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, making you feel as if a rug had been pulled from under your feet. You are 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:
You may like:
⚖️ Wondering whether to have a selective reduction or not? Take the Test
Selective terminations are most frequently performed within the second trimester, after prenatal screenings have revealed congenital defects. Oftentimes 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.”
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 taken into consideration.
The mention of selective abortion would conjure up a full range of concerns and emotions, putting the expectant mother in a state of emotional turmoil.
After all, 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 simply 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:
- 💡 Solution Finder Test
- 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 Grief Support Group (Twin to Twin Transfusion Syndrome): 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).
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.
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. At this point sex selection is sometimes offered.
- 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(s). 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) the use of 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.
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 decide?
- What about the surviving sibling – will it realize what has happened?
- How would I cope if this decision leads to a miscarriage and all the babies die?
No matter where you are in the thought process, know that this is your decision. Even if your doctor is recommending a certain path, you have the freedom to listen to your gut instinct. What is your heart telling you? You have the right to receive medical support and have the option of seeking a second opinion.
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.
- Start by taking the ⛑ First Aid Test!
- Wondering what type of mom you are: 👥 Take the Personality Test
- Know your strengths! 💪 Take the Strengths Finder Test
You may also like:
While profemina aims to provide you with the most up-to-date information possible, we cannot guarantee the accuracy of regulations and statistics listed in this article.