Twin-To-Twin Transfusion Syndrome, Reduction of Multifetal Pregnancy

This syndrome occurs specifically to twins that share the same placenta. There are some cases in which the placenta contains blood vessels that interconnect with the two fetuses, and this can cause them to exchange blood between each other. If the distribution of blood is not equal, as can occur, the fetus that gets more blood grows more and produces more amniotic fluid, whereas the other one can suffer from a growth restriction and have less amniotic fluid in the sac. While it is true that this situation can be serious, fortunately it only affects a ten out of fifteen percent of twins that share the same placenta.

Reduction of Multifetal Pregnancy
So what is multifetal pregnancy reduction? In the past few years, a procedure called multifetal pregnancy reduction has been used for women that have a very high numbers of fetuses, especially in the cases of women with four or more. This process entails injecting one or more fetuses with a lethal medication, causing fetal death. The intention of multifetal reduction is that by reducing the number of fetuses in the pregnancy, the remaining fetuses will be capable of having a better probability for health and survival.

Generally the specialist will in maternal multifetal pregnancy reduction will do the reduction during the last weeks of the first term, between weeks nine and thirteen and this is done in a specialized centre. The risk factor is fairly low when it is done by a specialized doctor. The important thing is to determine the options, so that all the information possible is available to make the right decision.

Selective Termination
The option of carrying out a selective termination can be used in a multifetal pregnancy in order to eliminate one of the fetuses in the case where there is a significant abnormality. A specialist in maternal fetal health can do this procedure if the fetuses have independent placentas, as this will not allow the medication to affect one of the fetuses. In the case of twins that share the same amniotic sac, there are other options available that you should talk about with your doctor. However there are not many centers where this procedure is practiced.