Selective reduction of multifetal pregnancies.

Selective reduction was carried out in 46 multifetal pregnancies by means of potassium chloride injection into the pericardial region of the fetus. There were three indications for the procedure: to improve perinatal outcome and to increase the likelihood that a term infant would be born in a multifetal pregnancy (34 women); to allow the birth of a healthy infant without the birth of a congenitally abnormal coexisting fetus (8 women); and to preserve a singleton pregnancy when the woman would otherwise have the whole pregnancy terminated (4 women). Of the 80 fetuses left after reduction 75 (94%) have survived. In 3 cases ultrasound scanning showed cardiac activity in the injected fetus 20-30 min after the initial injection despite 2 min of asystole immediately after the injection; repeated injection, carried out the same day, led to fetal death in all 3 cases. Selective reduction of multifetal pregnancies for the three indications described is an ethically justifiable option for the management of multifetal pregnancy, to which there are no public policy obstacles.