Selective Reduction: What You Need To Know

Definition
Selective abortion, also known as selective reduction, refers to choosing to abort a fetus, typically in a multi-fetal pregnancy, to decrease the health risks to the mother in carrying and giving birth to more than one or two babies, and also to decrease the risk of complications to the remaining fetus(es). The term selective abortion also refers to choosing to abort a fetus for reasons such as the woman is carrying a fetus which likely will be born with some birth defect or impairment, or because the sex of the fetus is not preferred by the individual.

Purpose
A woman may decide to abort for health reasons, for example, she is at higher risk for complications during pregnancy because of a disorder or disease such as diabetes. A 2004 case reported on an embryo embedded in a cesarean section scar. Although rare, it can be life threatening to the mother. In this case, selective abortion was successful at saving the mother and the remaining embryos.
However, selective reduction is recommended often in cases of multi-fetal pregnancy, or the presence of more than one fetus, typically, at least three or more fetuses. In the general population, multi-fetal pregnancy happens in only about 1-2% of pregnant women. But multi-fetal pregnancies occur far more often in women using fertility drugs.

Precautions
Because women or couples who use fertility drugs have made an extra effort to become pregnant, it is possible that the individuals may be unwilling or uncomfortable with the decision to abort a fetus in cases of multi-fetal pregnancy. Individuals engaging in fertility treatment should be made aware of the risk of multi-fetal pregnancy and consider the prospect of recommended reduction before undergoing fertility treatment.

Description
Selective reduction is usually performed between 9 and 12 weeks of pregnancy and is most successful when performed in early pregnancy. It is a simple procedure and can be performed on an outpatient basis. A needle is inserted into the woman's stomach or vagina and potassium chloride is injected into the fetus.

Preparation
Individuals who have chosen selective reduction to safeguard the remaining fetuses should be counseled prior to the procedure. Individuals should receive information regarding the risks of a multi-fetal pregnancy to both the fetuses and the mother compared with the risks after the reduction.
Individuals seeking an abortion for any reason should consider the ethical implications whether it is because the fetus is not the preferred sex or because the fetus would be born with a severe birth defect.

Aftercare
Counseling should continue after the abortion because it is a traumatic event. Individuals may feel guilty about choosing one fetus over another. Mental health professionals should be consulted throughout the process.

Risks
About 75% of women who undergo selective reduction will go into premature labor. About 4-5% of women undergoing selective reduction also miscarry one or more of the remaining fetuses. The risks associated with multi-fetal pregnancy are considered higher.

Normal results
In cases where a multi-fetal pregnancy of three or more fetuses is reduced to two fetuses, the remaining twin fetuses typically develop as they would if they had been conceived as twins.


Key Terms
Multi-fetal pregnancy: A pregnancy of two or more fetuses.
Selective reduction: Typically referred to in cases of multi-fetal pregnancy, when one or more fetuses are aborted to preserve the viability of the remaining fetuses and decrease health risks to the mother.