What We Offer

Multifetal Pregnancy Management

Over the past two decades, the number of twin pregnancies has more than doubled. There has been a 13-fold increase in triplets, the rate of quadruplets has increased 100 times, and there had been a 1,000 fold increase in quintuplets. For patients with multiple pregnancies, the risks of loss, prematurity, congenital anomalies, and poor neonatal outcomes are dramatically higher than for singletons. Over the past 30 years, Dr. Evans has been a pioneer in the practice of multifetal pregnancy reduction (MFPR) having performed thousands of such procedures for patients starting with between 2 to as many as 12 fetuses. The procedure has been demonstrated to be a safe way to significantly reduce the risks of multiple pregnancies. Patients with triplets or higher have their risks cut by more than half by reducing to twins. For twins, the risk of pregnancy loss and prematurity can be further cut by reducing to a singleton. We typically see patients for MFPR at about 12 weeks. For the 80% of our patients who are also having CVS, the procedures are done usually on two consecutive days.






The improvements in outcome fall into two different categories:

• •Reduced pregnancy loss rates


• •Reduced prematurity and its complications

With multiples of all starting numbers – if one defines success as healthy mother and healthy family – fewer are always safer. While the improvement is most dramatic with higher numbers, the percentage improvement is substantial for all starting numbers. For example reducing triplets to twins cuts the loss rate from about 15% to 4%, and for twins from about 8% to 2.5%. The average delivery of triplets is 32 weeks, twins 35 weeks, and singletons 38-39 weeks. The cerebral palsy rates are likewise dramatically cut. In some situations such as with a monozygotic twin set in a higher order multiples, the risks of carrying them are considerably increased above the specific fetal numbers:



The following articles are provided as further information.

• •Multifetal Pregnancy Reduction: Evolution of the Ethical Arguments (By Mark I. Evans, M.D., and David W. Britt, Ph.D)


• •The Truth About Multiples (By Mark I. Evans, M.D.)