Photo/Illutration Currently, there are no official medical guidelines or records in Japan regarding the selective reduction of fetuses in high-order pregnancies. This procedure is intended to reduce health risks to the mother and remaining fetuses. (Asahi Shimbun file photo)

In a landmark step toward addressing the medical and ethical complexities of fetal reduction in Japan, the country’s first clinical study on the procedure has been conducted by researchers at the University of Osaka.

The procedure involves lowering the number of fetuses in a multiple pregnancy to lessen the physical burden on the mother and reduce risks of premature birth and postpartum hemorrhage.

Although it has been practiced due to its necessity in some high-risk pregnancies, selective fetal reduction has rarely been addressed openly in Japan out of ethical concerns and a lack of formal medical guidelines.

“Because so few medical institutions disclose that they perform fetal reduction, some pregnant women feel conflicted,” said professor Masayuki Endo, an obstetrics and gynecology specialist leading the research at the university.

“We need to create a society where this is recognized as a valid option for women with multiple pregnancies,” he added.

Osaka University Hospital has already begun offering the procedure to general patients, marking a rare instance of public disclosure.

The research team performed the procedure on 10 women between April and December 2024.

Participants were selected from a group of consenting individuals with triplet or higher-order pregnancies involving more than three fetuses. Others who participated were pregnant with twins and facing serious maternal health conditions.

The procedures were conducted during weeks 11 to 13 of pregnancy using potassium chloride injections to stop the heartbeat of the selected fetus.

The team confirmed the effectiveness of the procedure in all 10 cases, with one requiring a second procedure after a fetus' heartbeat resumed the next day.

The survival rate for the remaining fetuses was approximately 90 percent.

The study also examined the mental health of the participating women. Many reported anxiety or depressive symptoms before the procedure, which slightly improved afterward but remained relatively high.

The study results were expected to be presented at a meeting of the Japan Society of Perinatal and Neonatal Medicine, which began on July 13.

The university plans to continue monitoring the women’s physical and emotional well-being post-delivery.

It also plans to collaborate with other institutions over the next three to five years to develop standardized and safe methods for fetal reduction.

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