Survey: 30% of Japanese university hospitals admitted patients after multifetal reduction, at least 42 cases since 2020
A November 2025 survey found about 30% of Japanese university hospitals admitted pregnant women after multifetal reduction, exposing legal gaps and prompting calls for clear guidelines. The survey, carried out among hospitals affiliated with medical colleges, identified at least 42 women who sought care at university facilities after undergoing the procedure elsewhere. Medical specialists and bioethicists are urging rapid policy work to clarify clinical standards and ensure patient safety.
Survey findings and hospital participation
A targeted survey in November 2025 contacted 90 hospitals affiliated with 82 universities and post-secondary institutions and received 72 responses. Roughly three in ten responding university hospitals reported admitting pregnant women who had previously undergone multifetal reduction at other facilities. Respondents included large referral centers that typically manage high-risk pregnancies and neonatal care.
Scope of documented multifetal reduction cases
While only one respondent acknowledged performing multifetal reductions during the January 2020–October 2025 window, 27 hospitals across 17 prefectures said they had received patients after reductions performed elsewhere. Interviews with those hospitals tallied at least 42 such admissions since 2020, underscoring that the practice is occurring beyond isolated clinics. Separate reports indicate fertility clinics and specialized maternity centers also conduct the procedure, though they seldom publicize it.
Patient referrals and interfacility transfers
During the same period covered by the survey, six hospitals reported referring at least nine pregnant women to other facilities specifically for multifetal reduction. University hospitals frequently act as receiving centers when complications or high-risk conditions develop after initial procedures. The pattern of transfers and admissions highlights a network of care that often crosses institutional boundaries, complicating oversight and follow-up for both patients and clinicians.
Legal ambiguity sparks calls for regulation
Multifetal reduction procedures currently occupy a legally uncertain space in Japan, with no uniform statute or national guideline explicitly governing when and how they should be performed. Medical professionals and bioethics experts say the absence of clear regulation creates risks for clinicians and patients alike, from consent processes to postoperative care responsibilities. Yukiko Saito, an associate professor of bioethics at Kitasato University, said transparency and prompt establishment of rules are essential to protect both mothers and remaining fetuses.
Medical risks, technique and ethical concerns
Clinicians explain that multifetal reduction is used to reduce risks associated with high-order multiple pregnancies, including preterm birth and hypertensive disorders, by reducing the number of fetuses carried. The procedure can involve injection of medication into a selected fetus to stop cardiac activity, a technique that raises complex ethical questions about fetal selection and informed consent. Medical teams must balance the potential for improved maternal and neonatal outcomes against the moral and psychological impacts for parents and caregivers.
Research activity and the University of Osaka study
A team at the University of Osaka announced in summer 2025 that it had completed Japan’s first clinical study of multifetal reduction and is planning a new multicenter joint clinical study. When asked about participation in the upcoming study, eight university hospitals responded affirmatively and 23 said they were considering joining, indicating growing institutional interest. Researchers say that systematic clinical data from multiple centers will be critical to develop evidence-based protocols and to evaluate short- and long-term outcomes for mothers and surviving infants.
Suwa Maternity Clinic in Nagano Prefecture is among the longstanding facilities that have performed multifetal reductions, with records of activity dating back to 1986. Local fertility clinics and private obstetrics centers likewise perform reductions in some cases, often as part of reproductive medicine services. Because many institutions do not publicly disclose such procedures, the true number performed nationwide remains unknown.
Clinical leaders emphasize practical steps that could be taken rapidly, including standardizing informed-consent forms, defining which clinical indications justify reduction, and setting follow-up care obligations when patients are transferred between facilities. Clear guidance could also help clarify reporting expectations and improve transparency about outcomes.
Many obstetricians say that while multifetal reduction may lower some perinatal risks, it also places a burden on clinicians required to counsel patients through ethically fraught choices under time pressure. Bioethics experts stress the need for multidisciplinary input—including obstetrics, neonatology, ethics, law and patient advocacy—when drafting national guidelines. They also urge transparent reporting systems to monitor safety and long-term results.
The survey’s findings point to a pressing need for national-level discussion and coordinated clinical guidance so that women receiving multifetal reductions, and the facilities that treat them afterward, operate under consistent standards. Policymakers, medical societies and research institutions will need to work together to close legal gaps and develop evidence-based protocols that protect patients, clarify professional responsibilities and address the ethical dimensions of care.
