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. 2015 Nov 4;2015(11):CD003932.
doi: 10.1002/14651858.CD003932.pub3.

Reduction of the number of fetuses for women with a multiple pregnancy

Jodie M Dodd  1 , Therese Dowswell, Caroline A Crowther
Affiliations

Reduction of the number of fetuses for women with a multiple pregnancy

Jodie M Dodd et al. Cochrane Database Syst Rev. .

Abstract

Background: When couples are faced with the dilemma of a higher-order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long-term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses.

Objectives: To assess a policy of multifetal reduction with a policy of expectant management of women with a multiple pregnancy.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2015).

Selection criteria: Randomised controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a multiple pregnancy.

Data collection and analysis: We planned that two review authors would independently assess trials for inclusion and risk of bias, extract data and check them for accuracy. However, no randomised trials were identified.

Main results: There were no randomised controlled trials identified.

Authors' conclusions: We found no available data from randomised trials to inform the risks and benefits of pregnancy reduction procedures for women with a multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures, reduction in the number of fetuses by selective termination may not be acceptable to women, particularly couples with a past history of infertility. The acceptability of this option, and willingness to undergo randomisation will depend on the couple's social background and beliefs, and consequently, recruitment to such a trial may prove exceptionally difficult.

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Conflict of interest statement

Therese Dowswell is employed by the University of Liverpool on an NIHR Cochrane Programme grant to work on a range of Cochrane Reviews. In the last three years the University of Liverpool has received a grant from the World Health Organization (WHO) for work on other Cochrane reviews that Therese has worked on. Therese has also received payment from WHO for working on other Cochrane reviews in the last three years. The Funders have no influence on the content or conclusions of the relevant Cochrane reviews.

Update of

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References to other published versions of this review

Dodd 2003
    1. Dodd JM, Crowther CA. Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD003932] - DOI - PubMed
Dodd 2012
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