Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies

BACKGROUND:When couples are faced with the dilemma of a higher order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses. OBJECTIVES:To assess a policy of multifetal reduction with a policy of expectant management of women with a triplet or higher order multiple pregnancy. SEARCH STRATEGY:We searched the Cochrane Pregnancy and Childbirth Group trials register (30 September 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002), and PubMed (to 30 September 2002). SELECTION CRITERIA:Randomized controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a triplet or higher order multiple pregnancy. DATA COLLECTION AND ANALYSIS:Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS:There were no randomised controlled trials identified. REVIEWER'S CONCLUSIONS:There are insufficient data available to support a policy of pregnancy reduction procedures for women with a triplet or higher order multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures, reduction in the number of fetuses by selective termination may not been acceptable to women, especially for those with a past history of infertility. The acceptability of this option, and willingness to undergo randomisation will depend on the couple's social background and beliefs, and consequently, recruitment to such a trial may prove exceptionally difficult