Evolution of gender options in multiple pregnancy management. (8th July 2013)

• Record Type: Journal Article
• Authors: Evans, Mark I.; Rosner, Mara; Andriole, Stephanie; Alkalay, Avishai; Gebb, Juliana; Britt, David W.
• Is Part Of: Prenatal diagnosis. Volume 33:Number 10(2013:Oct.)
• Page Start: 935
• Page End: 939
• Publication Date: 2013-07-08
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4167
• Languages: English
• ISSNs: 0197-3851

Abstract

ABSTRACT: Objective: Fetal reduction (FR) in multiples dramatically improves outcomes. We prioritize FR decisions for health and historically declined to factor gender. As male preferences apparently diminished, our bioethicist encouraged a re‐evaluation. Methods: Three hundred ninety‐six patients reducing triplets or twins were categorized as 3➔2, 3➔1, and 2➔1, Major (M) anomaly or minor (m) anomaly, same gender (SG), and those for whom gender preference (GP) was possible. Higher order and non chorionic villus sampling were excluded. FR decisions were prioritized by M anomaly, Suspicious, or m anomaly. If neither, we considered GP. Results: Of 319, 214 (67%) had either M/m or SG. Of those, 3➔2 with gender option: 71/79 chose male and female or had no preferences, one chose male/male, and seven chose female/female. We reduced monochorionic twins in 33/35 3➔1 cases. Of 20 with GP choice, 10 chose male and 10 chose female. Of 162 2➔1, 54 had M or m, 50 were SG, but of the 44 M/F twins, 20 chose male and 24 chose female. Conclusions: There has been a cultural shift mostly preferring one of each or having no preference. When reducing to one, >50% prefer a girl. In addition to identifying abnormalities, chorionic villus sampling before FR expands patient autonomy. © 2013 John Wiley & Sons, Ltd. Abstract : What's already known about this topic? Fetal reduction significantly improves outcomes in multiples; fetal gender in the decision has generally been unavailable or deliberately ignored because of historical biases against females. What does this study add? We routinely obtain genetic studies before reduction. We report here an apparent major shift in culture such that now females are as equally desired as males. As such, we feel justified in allowing gender to be a secondary determinant in FR cases.