Abstract
Objective:In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cord coagulation with lasers are the methods proposed for selective fetal reduction. This study brings forth preliminary data of selective fetal reduction procedures at a tertiary care center in India.Material and Methods:This was a prospective observational study of 31 patients with complicated mono-chorionic twin pregnancies. Methods used were ILA, RFA and BPCC. Outcome measures included overall co-twin survival after selective feticide, survival rates with each method, miscarriage (defined as all fetal loss before 24 weeks), early fetal death (<24 hours after procedure) and late fetal death (>24 hours after the procedure) of co-twin.Results:Technical success was achieved in 30/31 (96.8%) of pregnancies. Over all take home baby rate was 63.3%. Live birth rates were 50%, 71.4% and 75% with ILA, RFA and BPCC respectively.Conclusion:Data from initial cases of selective fetal reduction in complicated mono-chorionic twins suggests that these procedures are feasible but are associated with high adverse perinatal outcome.
Highlights
It is a well-accepted fact that multiple pregnancies have higher maternal complications and fetal complications [1]
Mono-chorionic twins have a unique set of complications like twin to twin transfusion syndrome (TTTS), selective fetal growth restriction, and twin reversed arterial perfusion sequence (TRAP)
Vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy-guided cord coagulation with laser are the methods proposed for selective fetal reduction in complicated monochorionic twins [6]
Summary
It is a well-accepted fact that multiple pregnancies have higher maternal complications (abortion, preterm labor, preterm pre-labor rupture of membranes, hypertension in pregnancy, anemia, ante and post partum hemorrhage, mal-presentation, cesarean section) and fetal complications (malformations, intrauterine fetal growth restriction, and complications of prematurity ) [1]. Fetal reduction from twin to singleton in dichorionic twins is debatable, but selective termination in twin gestation discordant for malformations or genetic abnormality is acceptable [2]. Mono-chorionic twins have a unique set of complications like twin to twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), and twin reversed arterial perfusion sequence (TRAP). These complications are due to presence of inter-fetal vascular anastomosis, which may put one twin at risk of death and adversely affect health of the other twin. Fetal reduction using potassium chloride ( KCL) instillation in fetal thorax/heart is not an option in mono-chorionic twins due to the presence of placental vascular anastomosis.
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