JJ Hospital tells Bombay HC: Foetal reduction of abnormal twin in 26-week pregnancy risky

MUMBAI: Foetal reduction procedure for a 26-weeks-plus twin pregnancy will result in premature delivery of both foetuses, a panel of the state-run JJ Hospital told the Bombay high court on Monday.

"Selective foeticide (sic) at this time will result in preterm labour of both the foetuses," said the report submitted to Justices Gautam Patel and S G Dige.

A 34-year-old woman had moved the HC for permission as the Medical Termination of Pregnancy (Amendment) Act, 2021, allows termination up to 24 weeks. However, it carves out an exception in case of substantial foetal abnormalities. Her petition said she got pregnant after undergoing in vitro fertilisation in Mumbai in July. In August, she learnt about her twin pregnancy, and returned to the US where her husband works. In November, a chromosomal array test diagnosed one foetus with a genetic chromosomal anomaly.

Counselled about its impact, they immediately returned to India. Jaslok Hospital advised foetal reduction. The woman moved the HC, and on December 28, the HC directed the setting up of a medical board and sought a report on the impact of foetal reduction.

The report submitted by government pleader Poornima Kantharia said "one of the foetuses is suffering from chromosomal abnormalities which can have a risk of physical and mental abnormality which will add on to morbidity and mortality". As the pregnancy has advanced to more than 26 weeks, it cautioned against "selective foeticide" that could end in pre-term delivery of both foetuses.

The judges observed that if the procedure is carried out, both foetuses would be two months premature. They seemed cagey about the procedure pre-term as the healthy foetus would be affected. "There could be cerebral palsy and hundreds of other issues," said Justice Patel.

"In the interest of the normal foetus, it will be advisable to defer the procedure of foeticide by a few weeks, depending on the opinion of the obstetrician who will be carrying out such a procedure. The risk of termination is not going to be more than that of normal labour," said the report.

The woman's advocate, Aditi Saxena, suggested that the court could direct foetal reduction to be undertaken at a later date. The judges were disinclined, and said they would take an update every two weeks.

In the order, the judges noted that "this is an unusual case". In view of the report, they posted the matter on January 16 to take an update from the woman's obstetrician and also from the medical board. The woman has to appear before the board on January 12.