What is Selective Reduction (multi-fetal reduction)?
This is the process of eliminating some of the fetuses in a multiple pregnancy. Perinatologists and Maternal-Fetal Specialists perform the procedure between 9-13 weeks gestation. The process, or at least mine, involved 2 days. Here's the process:
Day 1: Geneticist discussion, determining what if any genetic concerns and preparing the lab to specifically test chromosomes known to carry those disorders. CVS testing (explained here) is typically performed on one or more fetuses. Needles are trans-abdominally used to collect these samples (ie, they stick needles in through your belly). This process does not hurt, but can cause some quick cramping, or so I've experienced). Some doctors may not offer this, so if you elect to have it done, ask your provider about availability and costs. CVS is generally safer than an amniocentesis, as a cells are gathered from the placenta and not the amniotic fluid. From those genetic samples, a 24 hour quick test (FISH) is run to rule out all major genetic disorders and determine the sex of the fetus.
Day 2: You will receive the results from the 24 hour genetic sample labs, if you chose to do this. If not, you and your provider *should* have already discussed how many fetuses and which to maintain. The process of selective reduction is short, prep time was about 30 minutes, the actual procedure was approximately 2. Again, trans-abdominally, needles are used to inject the fetus(es) with potassium chloride. Within days, they will then be absorbed by the remaining placenta(s). Further and complete description of the process can be found: here.
In the days there after, women can experience some cramping and spotting. I, however, did not experience any of this. Having been preeclamptic, I noticed that within 24 hours, I was feeling better and I was able to eat, in small portions (I'd lost 20+ lbs in first trimester). Your doctor should advise you no heavy lifting or exercise for a few days thereafter.
Women can choose to share their choice with their regular OB/GYN if they so choose. I did, as my OB/GYN was very supportive of my decision. The pregnancy will simply appear as though a fetus or fetuses has miscarried. Nothing is visible during the ultrasound to a non-medically trained individual and therefore, should you choose to keep this entirely private--it's fine.
My only bit of advice is this: get several opinions on the viability of your pregnancy and your own health when considering Selective Reduction. I got several opinions on the matter and when the 3rd doctor had the same answer as the first two, I felt confident in my decision to Selectively Reduce. Having a variety of opinions helps you make the most informed decision. Especially when it comes to somewhat fragile or complex pregnancies.
In the links section of this website, there's a french study (link) that found women pressured into selective reduction by providers suffer many more regrets and bouts with depression. Women who did NOT feel pressured to selectively reduce, felt better about their choices. So, any provider that you perceive as encouraging a selective reduction...find a new doctor, stat! This choice is yours alone to make, and it is not up to a doctor, your parents, your friends...just you (and your partner) are to make this decision weighing all of the facts carefully.
Day 1: Geneticist discussion, determining what if any genetic concerns and preparing the lab to specifically test chromosomes known to carry those disorders. CVS testing (explained here) is typically performed on one or more fetuses. Needles are trans-abdominally used to collect these samples (ie, they stick needles in through your belly). This process does not hurt, but can cause some quick cramping, or so I've experienced). Some doctors may not offer this, so if you elect to have it done, ask your provider about availability and costs. CVS is generally safer than an amniocentesis, as a cells are gathered from the placenta and not the amniotic fluid. From those genetic samples, a 24 hour quick test (FISH) is run to rule out all major genetic disorders and determine the sex of the fetus.
Day 2: You will receive the results from the 24 hour genetic sample labs, if you chose to do this. If not, you and your provider *should* have already discussed how many fetuses and which to maintain. The process of selective reduction is short, prep time was about 30 minutes, the actual procedure was approximately 2. Again, trans-abdominally, needles are used to inject the fetus(es) with potassium chloride. Within days, they will then be absorbed by the remaining placenta(s). Further and complete description of the process can be found: here.
In the days there after, women can experience some cramping and spotting. I, however, did not experience any of this. Having been preeclamptic, I noticed that within 24 hours, I was feeling better and I was able to eat, in small portions (I'd lost 20+ lbs in first trimester). Your doctor should advise you no heavy lifting or exercise for a few days thereafter.
Women can choose to share their choice with their regular OB/GYN if they so choose. I did, as my OB/GYN was very supportive of my decision. The pregnancy will simply appear as though a fetus or fetuses has miscarried. Nothing is visible during the ultrasound to a non-medically trained individual and therefore, should you choose to keep this entirely private--it's fine.
My only bit of advice is this: get several opinions on the viability of your pregnancy and your own health when considering Selective Reduction. I got several opinions on the matter and when the 3rd doctor had the same answer as the first two, I felt confident in my decision to Selectively Reduce. Having a variety of opinions helps you make the most informed decision. Especially when it comes to somewhat fragile or complex pregnancies.
In the links section of this website, there's a french study (link) that found women pressured into selective reduction by providers suffer many more regrets and bouts with depression. Women who did NOT feel pressured to selectively reduce, felt better about their choices. So, any provider that you perceive as encouraging a selective reduction...find a new doctor, stat! This choice is yours alone to make, and it is not up to a doctor, your parents, your friends...just you (and your partner) are to make this decision weighing all of the facts carefully.