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Multifetal Pregnancy Reduction Guidelines

Obstet Gynecol; 2017 Sep; ACOG Comm on Ethics

Obstetrician-gynecologists play a key role in counseling and guiding patients as they make decisions regarding continuing or reducing their multifetal pregnancies. The American College of Obstetricians and Gynecologists (ACOG) offers a committee opinion on multifetal pregnancy reduction that includes the following recommendations:

  • Fertility treatments have contributed significantly to the increase in multifetal pregnancies. Primary prevention strategies to limit multifetal pregnancies, especially higher-order multifetal pregnancies, can help to minimize the need for multifetal pregnancy reduction and should be practiced by all physicians who treat women for infertility.
  • Obstetrician–gynecologists should be aware that multifetal pregnancies increase maternal and perinatal morbidity and mortality. Higher-order multifetal pregnancies present higher risks than do twin pregnancies.
  • Obstetrician–gynecologists should be knowledgeable about the medical risks of multifetal pregnancy, the potential medical benefits of multifetal pregnancy reduction, and the complex ethical issues inherent in decisions regarding multifetal pregnancy reduction.
  • Nondirective patient counseling should be offered to all women with higher-order multifetal pregnancies and should include a discussion of the risks unique to multifetal pregnancy as well as the option to continue or reduce the pregnancy.
  • When a patient’s request for information on multifetal pregnancy reduction is discordant with a physician’s values, the physician should refer the patient for consultation.


Multifetal pregnancy reduction. Committee Opinion No. 719. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e158–63.