It's the picture of Placenta. But it's not like other placentae.
The lady conceived after Infertility Treatment with Triplet. After explaining the merits and demerits of continuing the pregnancy as Triplet against the "Reduction" into Twin, she opted for "FETAL REDUCTION".
The GREEN arrow and the WHITE arrow in this picture point towards the separate placenta of EACH baby of Twin. However, both these placentae were FUSED together.
The ORANGE arrow points towards the fetus which was reduced to transform Triplet into Twin.
Multiple Pregnancy (more than one baby inside the Womb, like Twin, Triplet, Quadruplet) carries higher risk to mother and baby. The higher the number of the babies inside, the higher is the risk. The risks include increased risk of Miscarriage, Fetal Abnormally, Impaired Growth of the baby(s), Death of the baby and Premature Delivery (carrying the risk of NICU Admission, Breathing Problem, Feeding Problem, Infection, Chance of physical/ mental retardation). For mother, there is increased risk of high blood pressure (Preeclampsia), Diabetes, Anaemia, Vomiting, Bleeding and Clotting (Thrombosis).
Multiple pregnancy can happen spontaneously, especially in women with family history of twin and older women. However, the risk is higher with Infertility Treatment. IVF with multiple embryo transfer carries the highest risk. IUI and Ovulation Induction can also lead to Multiple Pregnancy.
Reduction of Twin to single baby is not advisable. But usually pregnancy carrying Triplet or higher number of babies can be "REDUCED" to Twin by selectively "DAMAGING" one or more baby. This is called "SELECTIVE FETAL REDUCTION". This is usually carried around 12-14 weeks, after NT scan, when we have an idea whether all the babies are growing and developing normally. The baby looking most abnormal is usually "damaged".
However, this procedure needs special expertise and needs to be carried out under ultrasound guidance by Fetal Medicine Expert. There is small risk that attempting to "kill" one baby may lead to miscarriage of all the babies. So we have to give the patients, the choice between continuing multiple pregnancy and selective fetal reduction.