Multifetal pregnancy reduction and selective termination

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Multifetal Pregnancy Reduction and Selective Termination Beriwal S et al. Multifetal pregnancy reduction and selective termination. TOG 2020;22:284–292. doi:10.1111/tog.12690

10.1→15.8 11–14wk <1:10 TWIN/HOM RATE PER 1000 MATERNITIES (PER OPTIMAL MFPR/ST GESTATION, INDEPENDENT PREGNANCY LOSS, INTRACARDIAC KCL BIRTH REGISTRY) CHORIONICITY (SINGLE REDUCTION)

DO N' T-M IS S FA C TS

  1. Chemical feticide (KCl) = independent chorionicity ONLY – contraindicated in monochorionic pregnancies (shared circulation risk)

  2. Optimal first-trimester MFPR/ST window: 11–14 weeks; risk increases after 16 weeks

  3. 3rd-trimester ST after 16wk: KCl at 32 weeks avoids extra miscarriage risk but 45% deliver within 2 weeks – give steroids first

  4. RFA: 110°C × 3 min per cycle, 15–27wk. BDCC: 30–50W ≤60s bursts, cord <12mm, 18–27wk

  5. MCDA cord occlusion overall survival ~77–79% pooled (BDCC 84% vs RFA 73%; PPROM 23% vs 11%)

  6. UK referral standards: tertiary FM by 11–14wk for MFPR discussion; within 5 days if fetal abnormality found

  7. Documentation: chorionicity/number confirmed before 14wk; complete UK HSA1 + HSA4 forms

  8. 30–70% of women undergoing MFPR have acute anxiety/trauma; long-term outcomes comparable to any live birth

TECHNIQUE VS CHORIONICITY

Independent chorionicity: intracardiac KCl (feticide)

Monochorionic/TRAP: RFA, BDCC, or intrafetal laser (vascular occlusion) – KCl contraindicated

ABBREVIATION KEY

MFPR — multifetal pregnancy reduction NT — nuchal translucency ST — selective termination CRL — crown–rump length

ART — assisted reproduction technology CVS — chorionic villus sampling

IVF — in vitro fertilisation RFA — radiofrequency ablation

MCDA — monochorionic diamniotic BDCC — bipolar diathermy cord coagulation

DCDA — dichorionic diamniotic TRAP — twin reversed arterial perfusion

DCTA — dichorionic triamniotic PPROM — preterm prelabour rupture of membranes

TCTA — trichorionic triamniotic ESHRE — European Society of Human Reproduction and Embryology KCl — potassium chloride HSA1/HSA4 — UK abortion certificate/notification forms FM — fetal medicine ARC — Antenatal Results and Choices

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Beriwal S et al. Multifetal pregnancy reduction and selective termination. TOG 2020;22:284–292. doi:10.1111/tog.12690

Clinically reviewed by NHS obstetricians and gynaecologists

MRCOG AI is an independent educational tool. It is not affiliated with, endorsed by, or connected to the Royal College of Obstetricians and Gynaecologists (RCOG).

Included with a Pass Package

Start free