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BOOK TITLE: Principles and Practice of Assisted Reproductive Technology
Fetal reduction involves the elimination of one or more of the fetuses in the multiple pregnancy, iatrogenically, in order to improve the perinatal outcome of the surviving fetuses. Decisions involving fetal reduction must be entirely autonomous. The pregnant mother should entirely make decisions for or against fetal reduction totally free of any stress or compulsion and must do it as per the directions of her thought processes after weighing the pros and cons completely. Ideally fetal reduction is usually scheduled between 11 and 12 weeks of pregnancy, as by this time spontaneous fetal demises if they should occur, would have already occurred. Another justification for performing this procedure at this period of gestation is that by the end 11 to 12 weeks, a nuchal translucency (NT) scan is also complete whereby an early scrutiny of the fetus to rule out anomalies is also done. A detailed informed consent is to be obtained by the “maternal fetal medicine specialist” from the patient after explaining the pros and cons of the procedure. Transcervical aspiration, transabdominal needling, and transvaginal needling are the techniques which are performed fetal reduction. Potassium chloride is the pharmacological agent which is commonly used in fetal reduction. It is not uncommon to have a failed attempt of fetal reduction. Hence, careful mapping of the fetus (to be reduced) is crucial, as the surviving fetus after a failed attempt of reduction can have sequelae.