CPT® Code 59866

1. Indications

Multifetal pregnancy reduction (MPR) is indicated in specific clinical scenarios where the health and viability of the remaining fetuses may be compromised due to the presence of multiple gestations. The following conditions may warrant the performance of MPR:

• High-Risk Multifetal Pregnancy: When a pregnancy involves three or more fetuses, the risk of complications such as preterm labor, gestational hypertension, and other maternal health issues increases significantly.
• Fetal Anomalies: The presence of significant fetal anomalies in one or more fetuses may lead to the decision to reduce the number of fetuses to improve the chances of survival and health for the remaining fetuses.
• Maternal Health Concerns: If the mother's health is at risk due to the demands of carrying multiple fetuses, MPR may be considered to alleviate these risks and enhance the likelihood of a successful pregnancy outcome.

2. Procedure

The procedure for multifetal pregnancy reduction involves several critical steps to ensure safety and effectiveness. Each step is carefully executed to minimize risks and achieve the desired outcome.

• Step 1: Patient Preparation The process begins with thorough patient counseling to discuss the implications of MPR, including potential risks and benefits. Following this, confirmation of gestational age is performed, typically between 9 to 12 weeks, along with fetal genetic testing to assess the viability of the fetuses.
• Step 2: Anesthesia and Cleansing Once the patient is prepared, the abdomen is cleansed to maintain a sterile environment. A local anesthetic is then administered to ensure the patient experiences minimal discomfort during the procedure.
• Step 3: Ultrasound Guidance Using ultrasound guidance, a needle is carefully inserted through the abdomen and into the uterus. This imaging technique allows the physician to visualize the fetuses and accurately target the selected fetus for reduction.
• Step 4: Injection of Potassium Chloride The needle is advanced into the thorax or another designated site of the selected fetus. A potassium chloride solution is injected, which effectively stops the fetal heart, leading to fetal demise.
• Step 5: Repetition of Procedure The procedure may be repeated as necessary until the desired number of viable fetuses is reached, ensuring that the remaining fetuses have a better chance of survival and health.

3. Post-Procedure

After the multifetal pregnancy reduction procedure, patients are typically monitored for any immediate complications. It is essential to provide appropriate post-procedure care, which may include pain management and emotional support, as the decision to undergo MPR can be emotionally challenging. Patients are advised to follow up with their healthcare provider to monitor the health of the remaining fetuses and the mother's well-being throughout the remainder of the pregnancy. Regular ultrasounds may be scheduled to assess fetal development and ensure that the pregnancy continues to progress healthily.