High order multiples and selective reduction

Since the advent of fertility treatments and specially invitro fertilization twins, triplets, quadruplets and higher order multiples are increasingly common. Being pregnant with triplets or more does pose significant health risks to the mother and the babies alike, and selective reduction is sometimes carried out to make the pregnancy more manageable.

Ideally, you would have discussed the possible risks of higher order multiples with your healthcare team before undergoing fertility treatment. Sometimes, such multiples are conceived naturally as well of course, which means you wouldn't have had the chance to consider the possibility of lots of babies all at once before you got pregnant. The chance of higher order multiples due to IVF can be reduced by implanting fewer embryos during each cycle.

Once you find out that you are expecting triplets or more, your doctor may advise you to look into selective reduction, or the abortion of one or more fetuses to lessen the risk of the pregnancy for you and the remaining fetus or fetuses. Before you could even consider such a step, you will want to know all about the risks of higher order multiple pregnancies.

As a blogger, I am not here to offer you information instead of your doctor. Some of the risks you will want to discuss with your healthcare team in detail are the following, though:

Premature babies. Statistics tell a frightening story about higher order multiples: 60 percent of twins are born prematurely, something that rises to a whopping 90 percent for triplets and nearly all quadruplets and up. The average gestational length for quadruplets is only 29 weeks. Just decades ago, nobody would have imagined that such babies had a realistic chance of survival. Low birth weight, which is associated with premature birth. Poor growth in the womb is another reason for low birth weight. Low birth weight is anything under 2,500 grams or 5 1/2 pounds, but higher order multiples are often born at much less. This brings many health risks, including cerebral palsy, hearing and vision problems, and other long-term health problems. Such babies also need very intensive medical care during the newborn period. Twin to twin transfusion syndrome. Where identical twins share a placenta, one baby can get too much blood and another too little. This occurs in about 10 percent of identical twin pregnancies, and there may well be identical twins among higher order multiples. Preeclampsia. This potentially life threatening pregnancy complication is much more likely to strike women who carry more than one fetus.

This list of risks is by no means an exclusive one. It is not a surprise that doctors, from a medical viewpoint, see selective reduction as the answer in some cases. We advise you to discuss the risks in great length before coming to a decision, and to keep in mind that, along with informed consent, the parents are responsible and have the right to make the final decision.