Editing Selective reduction (section)

{{Distinguish|Selective catalytic reduction}}
{{Short description|Abortion of one or more (but not all) fetuses in a multiple pregnancy}}
[[File:UOTW 19 - Ultrasound of the Week 1.webm|thumb|[[Monoamniotic twins|Monoamniotic]] triplets, a very rare condition where the triplets share a single placenta, seen on ultrasound. Because a single placenta has difficulty supporting multiple fetuses, in such cases a selective reduction to improve the likelihood of survival for the remaining fetus or fetuses may be indicated.<ref>{{cite web|title=UOTW #19 - Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-19/|website=Ultrasound of the Week|access-date=27 May 2017|date=23 September 2014|url-status=live|archive-url=https://web.archive.org/web/20170509073218/https://www.ultrasoundoftheweek.com/uotw-19/|archive-date=9 May 2017}} Triplets </ref><ref name=":0" />]]
'''Selective reduction''' is the practice of reducing the number of [[fetus]]es in a [[multiple pregnancy]], such as [[quadruplets]], to a [[twin]] or singleton pregnancy. The procedure is also called '''multifetal pregnancy reduction'''.<ref name=ACOG2017>{{cite web |title=Opinion Number 719: Multifetal Pregnancy Reduction |url=https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Multifetal-Pregnancy-Reduction |publisher=American College of Obstetricians and Gynecologists’ Committee on Ethics. |date=September 2017 |access-date=2018-10-26 |archive-date=2019-04-04 |archive-url=https://web.archive.org/web/20190404072926/https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Multifetal-Pregnancy-Reduction |url-status=dead }}</ref> The procedure is most commonly done to reduce the number of fetuses in a multiple pregnancy to a safe number, when the multiple pregnancy is the result of use of [[assisted reproductive technology]]; outcomes for both the mother and the babies are generally worse the higher the number of fetuses.<ref name=Legendre2013>{{cite journal |doi=10.1016/j.rbmo.2013.02.004 |pmid=23518032 |title=Differences between selective termination of pregnancy and fetal reduction in multiple pregnancy: A narrative review |journal=Reproductive BioMedicine Online |volume=26 |issue=6 |pages=542–54 |year=2013 |last1=Legendre |first1=Claire-Marie |last2=Moutel |first2=Grégoire |last3=Drouin |first3=Régen |last4=Favre |first4=Romain |last5=Bouffard |first5=Chantal |doi-access=free }} {{open access}}</ref> The procedure is also used in multiple pregnancies when one of the fetuses has a serious and incurable disease, or in the case where one of the fetuses is [[ectopic pregnancy|outside the uterus]], in which case it is called '''selective termination'''.<ref name=Legendre2013/>

The procedure generally takes two days; the first day for testing to select which fetuses to reduce, and the 2nd day for the procedure itself, in which [[potassium chloride]] is injected into the heart of each selected fetus under the guidance of ultrasound imaging.<ref name=Evans2014>{{cite journal |last1=Evans |first1=MI |last2=Andriole |first2=S |last3=Britt |first3=DW |title=Fetal reduction: 25 years' experience. |journal=Fetal Diagnosis and Therapy |date=2014 |volume=35 |issue=2 |pages=69–82 |doi=10.1159/000357974 |pmid=24525884|s2cid=5136936 |doi-access=free }} {{open access}}</ref>  Risks of the procedure include bleeding requiring transfusion, rupture of the uterus, [[retained placenta]], infection, a miscarriage, and [[prelabor rupture of membranes]]. Each of these appears to be rare.<ref name=Legendre2013/>

Selective reduction was developed in the mid-1980s, as people in the field of assisted reproductive technology became aware of the risks that multiple pregnancies carried for the mother and for the fetuses.<ref name=WaPO>{{cite news |last1=Mundy |first1=Liza |title=Too Much to Carry? |url=https://www.washingtonpost.com/wp-dyn/content/article/2007/05/15/AR2007051501730_pf.html |work=Washington Post Magazine |date=May 20, 2007 |archive-url=https://web.archive.org/web/20150405010648/http://www.washingtonpost.com/wp-dyn/content/article/2007/05/15/AR2007051501730_pf.html |archive-date=April 5, 2015}}</ref><ref name=NYT>{{cite news|title=The Two-Minus-One Pregnancy|url=https://www.nytimes.com/2011/08/14/magazine/the-two-minus-one-pregnancy.html|work=New York Times Magazine|first=Ruth|last=Padawer|date=August 10, 2011}}</ref>