Key takeaways
If you’re expecting triplets, quads or more, you should be seen by a specialist consultant in a Fetal Medicine Unit during your first trimester
Your consultant will explain the type of pregnancy you have, the risks for you and your babies and the options available
Selective reduction, also called multifetal reduction, may be discussed as one way to reduce the risks linked to higher-order multiple pregnancies
This can be an incredibly difficult and personal decision and every family will have their own views, circumstances and beliefs
Finding out you’re expecting triplets, quads or more can be a lot to take in. For some families, the pregnancy may have come after a long IVF journey. For others, it may have been completely unexpected. However your pregnancy happened, it’s normal to feel a mixture of emotions and to need time to understand what comes next.
Once your pregnancy has been confirmed, it is best practice for your care to be transferred to a Fetal Medicine Unit for an early review. Depending on the type of pregnancy you have and how it progresses, you may not need to stay under the care of the Fetal Medicine Unit throughout your whole pregnancy. However, you should be seen by a specialist consultant during your first trimester.
At this appointment, the consultant will carry out the checks and scans needed to understand the type of triplet, quad or higher-order multiple pregnancy you have. They will explain the possible risks for you and your babies and talk through the options that may help reduce those risks. This may include a discussion about selective reduction, also known as multifetal reduction.
This is part of routine specialist care in the NHS for higher-order multiple pregnancies. We want to help prepare you for that conversation so you feel as informed as possible.
Twins Trust supports families whatever decision they make. We understand how incredibly difficult this can be. Every family has their own views, circumstances and beliefs. We are here to support you with compassion and without judgement.
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What is selective reduction?
Selective reduction is a procedure to reduce the number of embryos or fetuses in a multiple pregnancy.
In a twin pregnancy, it may be offered if a congenital or genetic condition is found in one of the babies. In a triplet, quad or higher-order multiple pregnancy, it is usually discussed because of the increased risks linked to carrying three or more babies.
Selective reduction may also be called multifetal reduction.
Why is it offered?
Pregnancies involving three or more babies are sometimes called higher-order multiple pregnancies. These pregnancies carry higher risks, including miscarriage, stillbirth and premature birth.
Being born very early can also increase the chance of serious health complications for babies, including lifelong disability. There can be increased risks for the person carrying the pregnancy too, including high blood pressure, pre-eclampsia, gestational diabetes and other pregnancy complications.
Your consultant will look at your individual medical history and the details of your pregnancy. This will help them explain the specific risks that may apply to you and your babies.
Research shows that reducing the number of babies in a higher-order multiple pregnancy can reduce the chance of very early birth. This may lower the risk of complications linked to premature birth. However, the procedure can slightly increase the risk of miscarriage in the two to three weeks afterwards.
Your fetal medicine team will explain the risks and possible outcomes in detail so you can make an informed decision.
When would the procedure happen?
Guidance recommends that selective reduction is ideally carried out no later than 16 weeks of pregnancy, as this helps reduce the chance of miscarriage linked to the procedure. The earlier it takes place, the lower the risk is likely to be.
The procedure would be carried out by your fetal medicine team in a specialist unit. It is only performed by highly trained consultants with experience in this area.
What support is available when making this decision?
Your Fetal Medicine Consultant will offer an appointment to talk through your pregnancy, the risks and the options available to you.
It is important to be open about how you feel during this conversation. Ask any questions you need to ask. No question is silly, especially when you are making such a personal and difficult decision.
You may want to think about:
- How you feel about each option
- What the risks could mean for you and your babies
- How the decision could affect your family now and in the future
- What support you may need, whatever you decide
You do not have to make the decision immediately. Your care team should give you time to think, talk things through and ask further questions.
It may help to speak honestly with your partner, if you have one, or with someone you trust. You may also want to write down your questions before your appointment so you feel more prepared.
How Twins Trust can support you
If you would like further support, you can contact our support team. We are not medical professionals and cannot advise you on what decision to make, but we can listen, offer emotional support and help you find relevant information.
Whatever decision you make, we are here for you.
This information was written in collaboration with fetal medicine professionals.
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