read new article - "The tiniest patients: Operating inside the womb"

*Endorsed by the Society of Maternal-Fetal Medicine (SMFM).  Read their statement here.

Following the recent ruling of the Supreme Court of the United States (SCOTUS) in Dobbs v Jackson Women’s Health Organization, many states have severely restricted or prohibited abortion with other states planning to follow suit. These changes have resulted in inconsistent access to a full range of safe reproductive health options based upon location. These prohibitions disproportionately impact socioeconomically disadvantaged individuals and families, further exacerbating health care disparities.

The North American Fetal Therapy Network (NAFTNet) supports the rights of all individuals to access a full range of reproductive health services, including abortion care. There are many reasons for which individuals and families may consider abortion. Some reasons involve severe fetal diagnoses, such as life-limiting structural malformations, congenital infections, hydrops fetalis, and genetic abnormalities. Notably, many of these complications are not detectable in early pregnancy and may not become evident until the second or third trimester. Thus, gestational age limitations on abortion care affect the ability of individuals to make fully informed decisions on pregnancy management once a severe or potentially life-limiting fetal diagnosis has been detected.

Medical decision-making becomes particularly challenging when severe fetal diagnoses impact one fetus within twin or higher-order multiple gestations. In these discordant presentations, the existence of a twin with a poor prognosis can severely jeopardize the otherwise normal co-twin and threaten maternal health. For example, in a monochorionic (shared placenta) twin pregnancy, if one twin spontaneously dies in utero, its co-twin assumes a near-instantaneous risk of death (about 10%) or survival with profound and permanent neurological damage (around 20-30%).

Selective reduction procedures exist to strategically terminate one twin in a controlled setting within a discordant twin or higher-order multiple gestation. In the case of monochorionic twins, this intervention is intended to optimize maternal health and the outcomes for the continuing twin by minimizing the risk of death or severe neurologic injury. When the poor prognosis for one twin jeopardizes the potential healthy outcome of the other, the decision for many patients and families favors selective reduction.

Many other complex and nuanced multiple gestation presentations exist for which the option of selective reduction provides a safe, effective, and beneficial alternative. This includes higher-order multiple gestations, for which reduction of one or more fetuses may provide risk-reducing benefit. Selective fetal reduction can optimize obstetrical outcomes for the surviving fetus(es) in multiple gestations. In some situations, it can provide maternal health benefit. Thus, blanket prohibitions on abortion care are a disservice to pregnant individuals, limiting patient autonomy and compromising obstetrical outcomes.

NAFTNet supports providing individuals faced with complex multiple gestations and fetal diagnoses with a full range of reproductive health options, including access to abortion care and leaving management decisions to patients and families with the guidance of their physicians.