Multiple Gestation

Reducing Multiple Gestation in Pregnancy

Multiple gestation refers to a pregnancy in which two or more fetuses are present in the womb. In the general population, this occurs in approximately 1 to 2 percent of pregnancies. However, with the use of fertility drugs, multiple gestations are much more common. The vast majority of these pregnancies are twins, but triplets, quadruplets, and higher numbers can occur.

Fetal risks of multiple gestation include an increased chance of miscarriage, birth defects, premature birth, and the mental and/or physical problems that can result from a premature delivery. The average length of pregnancy is 39 weeks for a single gestation; 35 weeks for twins; 33 weeks for triplets; and 29 weeks for quadruplets. In general, the risks of complications due to premature delivery are significantly less once the pregnancy reaches 32-34 weeks gestation.

Maternal risks due to multiple gestation include premature labor, premature delivery, pregnancy-induced high blood pressure or pre-eclampsia (toxemia), diabetes, and vaginal/uterine hemorrhage.

Multi-fetal pregnancy reduction is a technique performed in less than 1 % of infertility patients.  This technique that reduces the number of fetuses in an effort to increase the likelihood that the pregnancy will continue. Consequently, the risks to the mother and remaining fetuses are reduced. This procedure is more likely to be performed when there are four or more fetuses present. The number of fetuses is often reduced to two, although in some circumstances they may be reduced to one. Because triplets and twins generally do better than higher-order multiples, reduction in these cases is rarely recommended, although it may be considered under special circumstances.

Multi-fetal pregnancy reduction is usually performed between 9 and 12 weeks gestation.

Dealing with the decision of whether or not to undergo multi-fetal pregnancy reduction can be a traumatic experience. Couples who have invested a great deal of time, money, and energy in pursuing pregnancy are often unprepared to make this decision. It is usually helpful for couples considering multi-fetal reduction to undergo professional counseling prior to undergoing the procedure with a highly skilled perinatalogist.