From twin to singleton

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7054.373 (Published 17 August 1996) Cite this as: BMJ 1996;313:373
  1. Richard L Berkowitz, Chairman
  1. Department of Obstetrics, Gynecology, and Reproductive Science, The Mount Sinai Medical Center, New York, NY 10029-6574, USA

    <it>If “psychological stress” is accepted for terminating singletons, it</it> <it>ought to be for reducing twins as well</it>

    The announcement last week that a British gynaecologist had electively reduced a twin pregnancy to a singleton for social indications has caused a furor in the international press. Before considering the issues raised by this particular case, we should distinguish it from two related situations. The first, selective termination, is usually defined as the termination of an anomalous fetus in a multiple pregnancy.1 The intent of this procedure is to selectively terminate an abnormal fetus and to allow the pregnancy to continue with the expectation that one or more healthy infants will subsequently be delivered. The second, multifetal pregnancy reduction, has also been in the news in Britain, after reports this week of a woman's decision to carry all eight fetuses conceived through fertility treatment. Multifetal pregnancy reduction refers to the termination of one or more presumably healthy fetuses in a pregnancy containing three or more fetuses. The objective here is to reduce the risk of very early preterm delivery associated with higher order multiple pregnancies, and therefore increase the chances of survival for the remaining fetuses.

    The first successful selective termination was reported in 1978.2 This procedure is usually performed in the second trimester and most often involves the termination of an abnormal twin. In a series of 69 consecutive selective …

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