Multifetal gestation, which accounts for approximately 3% of births, is a high-risk pregnancy being associated with adverse obstetric and perinatal complications with its consequences including neurodevelopmental handicaps. Multifetal pregnancy reduction aims to reduce the risk of miscarriage and extreme preterm birth at an acceptable procedure-related loss rate by terminating one or more fetuses. Selective termination for discordant anomalies in monochorionic pregnancies has advanced in recent years with the development of various vascular-occlusive techniques. Obstetricians should be knowledgeable about the medical risks of multifetal pregnancy, the potential benefits of these interventions and complex ethical issues inherent in the decisions.