Selective Feticide in Monoamniotic Twin Pregnancies by Umbilical Cord Occlusion and Transection

Abstract

Objectives: In monoamniotic twin pregnancies discordant for fetal anomaly, parents may opt for selective feticide. However, the normal co-twin remains at risk of sudden demise from cord entanglement. We report on three cases of successful selective feticide by cord occlusion combined with cord transection. Methods: We describe technical details and outcome of three monoamniotic twin pregnancies discordant for fetal anomaly (two cases of anencephaly and one case of congenital heart block) in which cord occlusion was followed by transection of the cord using contact laser. Results: The fetoscopic cord occlusion and transection using laser was successfully performed at 15, 16 and 19 weeks gestation, respectively. In one case, amniotic fluid leakage occurred after fetoscopy. The surviving co-twins were born at 36, 38 and 36 weeks gestation, respectively; two of the three were born vaginally and they were all healthy. Conclusion: In monoamniotic twins, selective feticide using laser occlusion and transection of the umbilical cord is technically feasible and can lead to near-term vaginal birth of healthy co-twins.