Perinatal outcomes between immediate vs deferred selective termination in dichorionic twin pregnancies with fetal congenital anomalies: a French multicenter study

Stanley Soussan; Charles Egloff; Violaine Peyronnet; Norbert Winer; Anne-Sophie Weingertner; Emmanuel Rault; Florent Fuchs; Thibault Quibel; Nicolas Bourgon; Alexandre J Vivanti; Jonathan Rosenblatt; Alice Ponzio-Klijanienko; Matthieu Dap; Laurent Mandelbrot; Olivier Picone; ISG study group

doi:10.1016/j.ajogmf.2024.101363

Perinatal outcomes between immediate vs deferred selective termination in dichorionic twin pregnancies with fetal congenital anomalies: a French multicenter study

Am J Obstet Gynecol MFM. 2024 Apr 2:101363. doi: 10.1016/j.ajogmf.2024.101363. Online ahead of print.

Authors

Stanley Soussan¹, Charles Egloff¹, Violaine Peyronnet², Norbert Winer³, Anne-Sophie Weingertner⁴, Emmanuel Rault⁵, Florent Fuchs⁶, Thibault Quibel⁷, Nicolas Bourgon⁸, Alexandre J Vivanti⁹, Jonathan Rosenblatt¹⁰, Alice Ponzio-Klijanienko¹¹, Matthieu Dap¹², Laurent Mandelbrot¹³, Olivier Picone¹⁴; ISG study group

Affiliations

¹ Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France; Universié Paris Cité, Paris, France.
² Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France.
³ Service de gynécologie-obstétrique, CHU de Nantes, Nantes, France.
⁴ Service de gynécologie-obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
⁵ Service de gynécologie-obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.
⁶ Service de Gynécologie-Obstétrique. CHU de Montpellier., Hôpital Arnaud de Villeneuve 371 Avenue du Doyen Gaston Giraud, Montpellier, France; Inserm CESP Centre de recherche en Épidémiologie et Santé des Populations, U1018, Équipe Épidémiologie Clinique, Villejuif; Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP), Univ Montpellier, INSERM, (CHU Montpellier), Montpellier, France.
⁷ Maternité, Centre hospitalier intercommunal de Poissy - Saint Germain en Laye, Poissy, France; Université Paris Saclay, UVSQ, Inserm, Équipe U1018, Épidémiologie clinique, CESP, Montigny-le-Bretonneux.
⁸ Service Obstétrique - Maternité, chirurgie médecine et imagerie fœtales, Hôpital Necker, AP-HP, Paris, France.
⁹ Service de Gynécologie - Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France.
¹⁰ Service de Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France.
¹¹ Service de gynécologie-obstétrique, Hôpital Port Royal, AP-HP, Paris, France.
¹² Service de gynécologie-obstétrique, CHRU de Nancy, Université de Lorraine, Nancy, France.
¹³ Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France; Universié Paris Cité, Paris, France; IAME, INSERM, Paris, France; FHU PREMA, Paris, France. Electronic address: laurent.mandelbrot@aphp.fr.
¹⁴ Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, Colombes, France; Universié Paris Cité, Paris, France; IAME, INSERM, Paris, France; FHU PREMA, Paris, France.

PMID: 38574858
DOI: 10.1016/j.ajogmf.2024.101363

Abstract

Background: Because selective termination (ST) for discordant dichorionic twin anomalies carries a risk of pregnancy loss, deferring the procedure until the third trimester can be considered in settings where it is legal.

Objective: To determine whether perinatal outcomes were more favorable following deferred rather than immediate ST.

Study design: A French multicenter retrospective study from 2012 to 2023 on dichorionic twin pregnancies with ST for fetal conditions which were diagnosed before 24 WG. Pregnancies with additional risk factors for late miscarriage were excluded. We defined two groups according to the intention to perform ST within 2 weeks after the diagnosis of the severe fetal anomaly was established (immediate ST) or to wait until the third trimester (deferred ST). The primary outcome was perinatal survival at 28 days of life. Secondary outcomes were pregnancy losses before 24 WG and preterm delivery.

Results: Of 390 pregnancies, 258 were in the immediate ST group and 132 in deferred ST group. Baseline characteristics were similar in both groups. Overall survival of the healthy co-twin was 93.8% (242/258) in the immediate ST group vs 100% (132/132) in the deferred ST group (p<0.01). Preterm birth < 37 weeks' gestation was lower in the immediate than in the deferred ST group (66.7% vs 20.2%, p<0.01); preterm birth < 28 WG and < 32 WG did not differ significantly (respectively 1.7% vs 0.8%, p=0.66 and 8.26% vs 11.4%, p=0.36). In the deferred ST group, an emergency procedure was performed in 11.3% (15/132) because of threatened preterm labor, of which 3.7% (5/132) for imminent delivery.

Conclusion: Overall survival after ST was high regardless of the gestational age at which the procedure was performed. Postponing ST until the third trimester seems to improve survival, while immediate ST reduces the risk of preterm delivery. Furthermore, deferred ST requires an expert center capable of performing the ST procedure on an emergency basis if required.

Keywords: Termination of pregnancy for fetal anomalies; dichorionic twin pregnancy; invasive procedure; late termination of pregnancy; neonatal survival; pregnancy loss; selective termination; twin pregnancy.