Selective termination in dichorionic twins discordant for congenital defect

Abstract

Objective: To evaluate the perinatal outcome of selective termination in dichorionic twins discordant for congenital defect, performed at the Hospital General Universitario Gregorio Marañon.

Study design: Twenty-eight dichorionic twins with an anomalous fetus were included from May 2008 to February 2011. Intracardiac KCl (1-2 ml; 15 mEq/ml) under ultrasonographic guidance was used in all procedures. Congenital defect, gestational age at the procedure, incidence and perinatal outcome were retrieved.

Results: Selective termination was performed in 14 (50%) cases of structural defects with normal karyotype and in 14 (50%) cases of chromosomal abnormality, 13 of them (92.8%) trisomy 21. Median gestational age at the procedure was 17.8 weeks (range 14.5-24; SD 2.3), and 12 (42.8%) were performed before 18 weeks. The presenting fetus was terminated in 11 cases (39.3%). Selective termination was followed by the subsequent delivery of a viable infant in 27 out of 28 cases (96.4%). Fetal loss before 24 weeks occurred in 1 case (3.6%). Median gestational age at delivery was 38 weeks (range 24.1-40.1; SD 3.8). Twenty-four (88.9%) were delivered >34 weeks and 1 (3.7%) before 28 weeks.

Conclusion: Selective termination in dichorionic twins discordant for congenital defect is a safe procedure with low risk of unintended fetal loss. This option is a reasonable alternative to expectant management or termination of the whole pregnancy.