59866 Multifetal pregnancy reduction(s) (MPR)

Name of the Procedure:

Common Name: Multifetal Pregnancy Reduction (MPR) Technical/Medical Term: Selective Reduction

Summary

Multifetal pregnancy reduction is a procedure used to decrease the number of fetuses in a multifetal pregnancy. This is often necessary in cases where multiple embryos have implanted after fertility treatment, or when one or more fetuses are diagnosed with a serious medical condition. The goal is to improve the chances of a healthy pregnancy and delivery.

Purpose

Multifetal pregnancy reduction addresses the risks associated with carrying multiple fetuses. These include preterm birth, low birth weight, and complications for both the mother and the babies. The intended outcome is to increase the likelihood of a healthier term pregnancy and reduce the potential for medical complications.

Indications

• High-order multiple pregnancies (triplets or more), particularly those conceived via assisted reproductive technologies (ART).
• Detection of significant genetic or structural anomalies in one or more fetuses.
• Maternal health conditions that could be worsened by carrying multiple fetuses.

Preparation

• Pre-procedure consultation to discuss risks, benefits, and alternatives.
• Ultrasound to assess the number of fetuses and their positions.
• Blood tests and other diagnostic assessments as recommended.
• Instructions may include fasting for a certain period before the procedure.
• Adjustments in medication as advised by the healthcare provider.

Procedure Description

1. Anesthesia: Local anesthesia or sedation is administered to the mother.
2. Ultrasound Guidance: A high-resolution ultrasound guides the entire process.
3. Injection: A fine needle, inserted through the abdomen or cervix, delivers a medication that stops the heart of the selected fetus(es).
4. Monitoring: Continuous ultrasound monitoring ensures precision and safety.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the number of fetuses and their positions.

Setting

Multifetal pregnancy reduction is usually performed in a hospital or a specialized outpatient clinic equipped with ultrasound facilities.

Personnel

• Specialist in maternal-fetal medicine or perinatology.
• Ultrasound technician.
• Anesthesiologist or nurse anesthetist.
• Nurses and other support staff.

Risks and Complications

• Procedure-related loss of the entire pregnancy (approximately 5-10% risk).
• Premature labor.
• Infection.
• Bleeding.
• Emotional and psychological impact.

Benefits

• Reduced risk of preterm birth.
• Lowered chances of complications for the remaining fetuses.
• Improved maternal health outcomes.
• The benefits can often be realized immediately through a healthier and more manageable pregnancy ongoing.

Recovery

• Post-procedure monitoring for a few hours.
• Limited physical activity for a few days.
• Pain and cramping management, typically with over-the-counter pain relievers.
• Follow-up ultrasound examinations and appointments with the healthcare provider.

Alternatives

• Continuing with the multifetal pregnancy with close monitoring.
• Elective termination of the entire pregnancy.
• Each alternative carries its own set of risks and benefits, which should be discussed in detail with a healthcare provider.

Patient Experience

• Discomfort during needle insertion.
• Possible cramping or light bleeding post-procedure.
• Emotional and psychological support may be needed. Pain management includes prescribed pain relievers and comfort measures as advised by the healthcare team.