Intracardiac Injection Of Potassium Chloride Research Articles

Feticide Before Termination of Pregnancy in Singleton Pregnancy - Trends in England and Wales 2012-2020, a Cross-sectional Study.

Feticide is the practice of inducing fetal demise before the termination of pregnancy. In England and Wales, it is recommended for terminations of pregnancy beyond 21+6 weeks of gestation. This project analyses the trends in feticide in singleton pregnancy in England and Wales between 2012 and 2020.This project was a retrospective study that analysed data extracted from the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC). The data extracted by the DHSC included the prevalence of feticide, methods of feticide and termination, statutory grounds, gestation, service provider, maternal age, ethnicity and obstetric history. In addition, data analysis was carried out to identify trends.Between 2012 and 2020, there were 9310 feticides in England and Wales, undertaken in 0.5% of all abortions. The prevalence of feticide fluctuated; however, there was an overall decrease from 1084 cases in 2012 to 1000 cases in 2020. Intracardiac injection of potassium chloride was the most frequent method of achieving feticide (67.2%). Just over half (55.8%) of feticides took place under Ground E of the Abortion Act 1967, with the main indication being congenital malformations of the nervous system. Two-fifths (40.2%) of feticides took place at 23 weeks, 22.8% at 22 weeks and 13.5% between 20 and 21 weeks. The remainder occurred at later gestations: 17.5% at 24-29 weeks and 5.9% beyond 29 weeks. During our study period, it was more common for feticides to be carried out as part of a medical termination than a surgical termination and 60.3% occurred in NHS hospitals. Women undergoing feticide were mostly aged 30-34 years (38.3%) and of White ethnicity (78.6%).Feticide is an essential component of comprehensive abortion care for women undergoing late second and third-trimester abortions. This study provides insight into how feticide is carried out in England and Wales and demonstrates the effect of the COVID-19 pandemic on reducing feticide prevalence. Future research should analyse in more detail the use of the different methods of feticide.

Minimally Invasive Management of Second Trimester Placenta Percreta

To describe the diagnostic and surgical challenges in the management of second trimester placenta percreta. Stepwise demonstration of the surgical technique with the use of an educational video. Second trimester placenta percreta is a rare entity, with very few case reports in the literature. Our video demonstrates the challenges of a minimally invasive approach toward definitive surgical management with hysterectomy. A 39-year-old G7P3 (3 previous cesarean deliveries) female at 17 weeks and 2 days gestation presented with acute abdominal pain to a community hospital. This was a spontaneously conceived pregnancy. Her hemoglobin level on admission was 92 g/L. An ultrasound showed a normal uterus, and the appendix was not visualized. One unit of packed red blood cells was transfused, and she underwent exploratory laparoscopy for a possible retrocecal hematoma/mass seen on computerized tomography. In the operating room, acute hemoperitoneum was visualized with placenta-like tissue invading through the anterior lower uterine segment (Figures 2 & 3). A hemostatic agent (Floseal, Baxter) was placed over the bleeding, and she was then transferred to a tertiary academic center for further management. Magnetic resonance imaging was performed on the following day after transfer to our facility, which confirmed placenta percreta at the level of the bladder (Figure 1). Following counseling with a multidisciplinary team and given that there was ongoing bleeding from the invading placental tissue, pregnancy continuation and uterine conservation were not possible. The patient was offered preprocedure termination of pregnancy with intra-cardiac injection of potassium chloride and 350 cc of amniotic fluid was drained at that time. This was done to facilitate visualization for a minimally invasive approach. We describe 5 main challenges of minimally invasive hysterectomy for placental percreta and provide a stepwise approach to mitigating them: visibility, vascular control, bladder dissection, colpotomy, and specimen retrieval. We adapted the previously described laparotomy techniques of progressive uterine devascularization and approach to bladder dissection and colpotomy to laparoscopy [1,2]. In addition, we performed dilatation and evacuation to allow for vaginal specimen removal. The patient's postoperative course was uncomplicated, and she was discharged home in a stable condition. Midtrimester placenta percreta poses significant challenges in diagnosis and surgical management. Total laparoscopic hysterectomy for this condition poses unique challenges but is feasible and safe.

Trends of Selective Fetal Reduction and Selective Termination in Multiple Pregnancy, in England and Wales: a Cross-Sectional Study

Selective abortion was shown to be increasingly common in England and Wales over a 9-year period, occurring most frequently as twin to singleton reductions in the 1st trimester. We analysed the trends in selective abortion (SA) in multiple pregnancies in England and Wales between 2009 and 2018. This is a cross-sectional study looking at 1143 women with multiple pregnancies in England and Wales undergoing SA. There were a total of 1143 cases of SA between 2009 and 2018 in England and Wales, representing 0.07% of total abortions. There has been a steady increase in cases, from 90 in 2009 to 131 in 2018, with 82.3% justified under ground E of The Abortion Act 1967. The majority of SAs were carried out at 13–19 weeks gestation, and intracardiac injection of potassium chloride was the most prevalent method (75%). Twin to singleton reductions accounted for 59%, the most common form of SAs. Over half of all cases (59%) were performed in women aged 30–39 years, and 84% of all women were of White ethnicity. SA has been an option available for couples diagnosed with multiple pregnancy, especially when there are discordant anomalies. Although SA may decrease multiple pregnancy-related complications, preventative methods must be championed.

Robotic Assisted Resection of 16 Week Uterine Horn Pregnancy: A Minimally Invasive Approach to the Second Trimester Ectopic Pregnancy

<h3>Study Objective</h3> To demonstrate by video our surgical approach of the resection of a second trimester rudimentary horn ectopic pregnancy. <h3>Design</h3> Case Report <h3>Setting</h3> University hospital. Patient in dorsal lithotomy position. <h3>Patients or Participants</h3> A 22-year-old primigravida presented at 16 weeks gestation following two failed elective terminations, in the setting of a spontaneous pregnancy with a known uterine anomaly. The patient reported a prior diagnostic laparoscopy revealing a left unicornuate uterus. Outside ultrasounds reported an intrauterine pregnancy however MRI upon admission revealed a fetus located within a thin-walled structure separate from the main uterine cavity, consistent with a rudimentary horn pregnancy. <h3>Interventions</h3> A fetal intracardiac potassium chloride injection was completed by maternal fetal medicine to halt the growth of the pregnancy during pre-operative planning. Tranexamic acid was administered preoperatively to minimize blood loss. Ureteral stents were placed to safely identify the ureters with the knowledge that Mullerian anomalies are often associated with concomitant renal abnormalities. Robotic assisted laparoscopy was used to resect the rudimentary uterine horn containing the 16-week gestation with ipsilateral ureterolysis and uterine artery ligation. <h3>Measurements and Main Results</h3> Exam under anesthesia and diagnostic laparoscopy revealed a unicornuate uterus with a communicating rudimentary horn. The procedure was uncomplicated with an estimated blood loss of 100cc. The patient's hemoglobin remained stable from 11.7 preoperatively to 10.8 postoperatively. She was meeting all milestones and discharged home on postoperative day one. <h3>Conclusion</h3> Rudimentary uterine horn pregnancies are rare and best managed by a multidisciplinary team. Robotic-assisted surgery may decrease blood loss, length of stay and comorbidities from surgery in the setting of a rudimentary horn ectopic pregnancy. Rather than assuming infertility, long-acting reversible contraceptives should be offered to women to prevent recurrence.

Maternal outcome of selective feticide due to fetal anomaly in late trimester: A retrospective 10 years' experience in Taiwan.

Feticide was suggested to avoid delivering children with abnormalities. Recently, twin pregnancies have increased. Selective feticide was proposed to achieve a good outcome of pregnancy. This study aimed to evaluate the performance of feticide in twin pregnancy with fetal anomaly. This was a retrospective study enrolled from 2009 to 2018. A total of 68 pregnancies with fetal anomalies received feticide. Potassium chloride was injected into the left ventricle to induce fetal asystole. Maternal and fetal characteristics of 16 dichorionic twins were documented to compare before and after 24th gestational week. All pregnant women received feticide without any maternal or fetal complication. The reasons for choosing feticide were divided into four groups, including morphologic defect (61.8%), genetic-chromosomal abnormality (30.9%), obstetrical complication (5.9%), and maternal request (1.5%). Mean gestational age at delivery was significantly higher in dichorionic twins who underwent selective feticide before than after 24th gestational week (36.7 vs 33.4, p = 0.04). Intracardiac injection of potassium chloride was effective for feticide and safe for mothers and fetuses. Selective feticide served as an alternative approach for twin pregnancy with fetal anomaly after sufficient discussion.

Retained Placenta Creta After Selective Fetal Reduction in Twin Pregnancy: A Case Report

Abstract Placenta accreta spectrum (PAS) disorders are severe obstetric complications and can cause life-threatening hemorrhage, hysterectomy, or even death. PAS disorders in one of dichorionic diamniotic twins are rare to be seen in clinical practice and lack of standard management strategies. We reported a case of retained placenta creta after selective fetal reduction in one of dichorionic diamniotic twins. A 32-year-old woman with a history of cesarean section was diagnosed with placenta increta in one of dichorionic diamniotic twins at 16 weeks of gestation. After discussion, the couple required to be hospitalized for selective fetal reduction. She received selective termination by ultrasound-guided single fetal intracardiac injection of potassium chloride. The follow-up prenatal ultrasound examinations detected the placenta of the reduced fetus did not stop invade the myometrium of the uterus but developed from placenta increta to placenta percreta. The patient was diagnosed with placental percreta by prenatal ultrasound signs and surgical findings. The patient underwent scheduled cesarean delivery at 34+5 gestational weeks. The outcome of maternal and fetal was satisfactory for our elaborate operation and optimal management. PAS disorders are severe obstetric complications with an increasing incidence. Combined with twin pregnancy makes PAS disorders more intractable. We should learn that selective fetal reduction probably cannot solve it thoroughly. Intensive and standard management is essential to promote maternal and fetal outcomes.

Protrusion of placental tissue through the cervical os as an unusual presentation of placenta accreta: A case report

IntroductionAbnormal placentation commonly occurs in women with a history of uterine surgery or placenta previa. Placenta accreta spectrum can occur in the setting of lesser-known risk factors and anatomical locations.CaseA 41-year-old woman (G6P4014) at 18 weeks of gestation without major risk factors was diagnosed with a placenta accreta after presenting for desired termination of pregnancy. On examination, placental tissue was found to be protruding through the cervical os and this was confirmed by magnetic resonance imaging (MRI). Management included pregnancy termination with intracardiac potassium chloride injection, uterine artery embolization, and a total abdominal hysterectomy.ConclusionProtruding cervical tissue should raise suspicion for placenta accreta. Appropriate evaluation and surgical planning should be performed to ensure a safe delivery.

Intra-cardiac feticide injection for cervical ectopic pregnancy less than 10 weeks of gestation: A case report and review of literature

Objective: To report a case of cervical ectopic managed by intra-cardiac injection of potassium chloride to terminate pregnancy. Design: Case Report . Patient: A 24-year-old G2P1+0, presented with vaginal bleeding. Cervical pregnancy (7 weeks+4 days) was diagnosed by transvaginal ultrasound. Intervention: Intra-cardiac injection of (KCL) was done plus intra-amniotic injection of methotrexate under ultrasound guidance. Outcomes: Safe pregnancy termination and uterine preservation. Results: Pregnancy was terminated successfully, without complications or side effects. Conclusion: Intra-cardiac injection of KCL appears to be an effective and safe method in termination of cervical ectopic pregnancy less than 10 weeks. Keywords: Cervical ectopic, Intra-cardiac feticide, Potassium Chloride, Methotrexate.

Ultrasound-guided induced fetal death, an alternative method for induction of abortion in the bitch.

This study was performed to achieve abortion in a short time and with minimum side effects in a bitch, as an alternative method for termination of unwanted pregnancy. The experimentation was performed on 10 privately owned crossbred pregnant bitches, in their late second trimester of pregnancy, having a variable number of fetuses (3 to 9). Fetal death was induced by transabdominal intracardiac injection of potassium chloride (KCl) into the fetal heart under ultrasonographic guidance. Pregnancy was terminated within 36 to 72 hr (51.60 ± 16.04 hr) and none of the patients experienced any side effects or clinical complications. Data presented in this report provided evidence for the possible use of this technique to selectively reduce the number of canine fetuses without terminating the whole pregnancy. Ultrasound-guided induced fetal death is a safe procedure and a viable method for the induction of abortion in a short time and with no apparent side effects.

Direct Methotrexate Injection into the Gestational Sac for Nontubal Ectopic Pregnancy: A Review of Efficacy and Outcomes from a Single Institution

To evaluate the efficacy of nontubal ectopic pregnancy (NTEP) management with direct methotrexate (MTX) injection into the gestational sac. A retrospective chart review. A tertiary academic and teaching hospital. All cases of confirmed NTEP were retrospectively identified from 2012 to 2017. Ultrasound-guided direct injection of MTX into the fetal pole and surrounding gestational sac and a single dose of systemic MTX with or without fetal intracardiac injection of potassium chloride. Treatment failure, complications from treatment, operating time, and days to negative serum human chorionic gonadotropin (hCG) after treatment were measured. Fourteen women (age 34 ± 5.2 years) with NTEP underwent direct MTX injection (cesarean scar, n = 4; interstitial, n = 6; cervical, n = 4). The mean estimated gestational age was 49 ± 11, CI (43, 56 days). One patient required laparoscopic intervention with a failure rate of 1 of 14 (a double interstitial, heterotopic pregnancy). There were no other major complications. The time in the operating room was similar for all NTEP types. The average time to negative serum hCG was not different for cesarean scar (84.5 ± 36 days), cervical pregnancies (70.5 ± 19 days), or interstitial pregnancies (45.3 ± 38 days, p = .15). Direct MTX injection into the gestational sac for NTEP treatment is safe and effective. The failure rate of 7% is considerably lower than what was previously reported for a failure of systemic MTX in similar cases (25%). Resolution of serum hCG after treatment can be quite prolonged even in uncomplicated cases.

DISCORDANT ANOMALIES IN MONOZYGOTIC TWINS

Monozygotic twins, as a rule, have the same genotype and phenotype. Cases, where disturbances develop in only one of two twins are very rare. Such cases are called discordant anomalies. The purpose of the work is to systematize the data on the causes of discordant anomalies, their phenotypic manifestations and methods of managing pregnancy in the case of discordant anomalies, search for articles on this topic in the PubMed database and analyze the found literature. Data analysis showed following factors to be able to serve as causes of discordant anomalies: mutations occurred both before and after the separation of the blastomeres; inactivation of one of the X chromosomes in women; variations in the number of copies of genes; different embryo attachment to the placenta; epigenetic factors. Most often there are discordant anomalies of the central nervous system, the cardiovascular system, and defects of the abdominal wall. There are less common chromosomal abnormalities - Down syndrome, Patau syndrome, Klinefelter syndrome. Isolated cases are cystic hygroma and autism spectrum disorders. The average gestational age at which discordant anomalies are detected is 17 weeks in monochorial twins, and 21 weeks in bichorial twins. Malformations of one of the fetuses increase the risk of the miscarriage or premature birth. When detecting twins, discordant for a large anomaly, selective reduction of embryos is appropriate. For bichorial twins, an intracardiac injection of potassium chloride is used. In monochorial twins, umbilical cord coagulation is used, because often monochorial fetuses have vascular anastomoses, and the cardiotoxic agent can enter into a healthy fetus. Discordant anomalies are rare, poorly understood pathology. Anomalies can affect any organ system, often there are multiple malformations. Large anomalies can be an indication for the selective reduction of the fetus.

Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths

Objective: The aim of this study was to characterise the imaging features seen in fetuses having undergone feticide by intracardiac potassium chloride injection compared to those of non-terminated fetuses at post-mortem magnetic resonance imaging (PMMRI). Methods: A case-control study was performed comparing PMMRI findings between two groups of patients – those having undergone feticide were matched to a control group of miscarried/stillborn fetuses. The groups were matched according to gestational age, weight, and time since death. Two independent readers reviewed the PMMRI for thoracic, abdominal, and musculoskeletal imaging features. The Fishers exact test was conducted for differences between the patient groups. Results: Twenty-six cases of feticide (mean gestation 25 weeks [20–36]) and 75 non-terminated fetuses (mean gestation 26.7 weeks [19–36]) were compared. There was a higher proportion of feticide cases demonstrating pneumothorax (23.1 vs. 1.3%, p = 0.001), haemothorax (42.3 vs. 4%, p = 0.001), pneumopericardium (30.8 vs. 5.3%, p = 0.002), and haemopericardium (34.6 vs. 0%, p = 0.0001). Intracardiac gas and intra-abdominal findings were higher in the feticide group, but the differences were not statistically significant. Conclusion: Characteristic PMMRI features of feticide can help improve reporter confidence in differentiating iatrogenic from physiological/pathological processes.

Outcomes of dilation and evacuation with and without feticide by intra-cardiac potassium chloride injection: a service evaluation

ObjectiveTo compare procedure duration, complications, and acceptability of dilation and evacuation (D&E) with and without feticide by intra-cardiac potassium chloride (KCL) injection. Study designWe evaluated outcomes with D&E at 18–24 weeks of gestation in the 6 months before and 6 months after removing feticide with KCL from the guidelines of a national British abortion provider. We extracted demographic and procedure-related data from medical records and electronic databases. We surveyed women undergoing D&E in both time periods about acceptability and side effects. ResultsWe analyzed 291 cases with and 257 cases without KCL. Unadjusted mean procedure duration was shorter with KCL than without (12.7 vs. 16.1 min, respectively, p<.001). After adjustment for age, parity, Cesarean deliveries, gestational age, body mass index, surgeon, and number or duration of osmotic dilators used, KCL remained associated with a 3.5 min (95% CI 2.4–4.6) reduction in D&E duration. Uterine atony was more common with KCL than without (3% vs. 0%, respectively, p=.004), despite more frequent administration of prophylactic utero-tonics to women who received KCL (82% KCL vs. 73% no-KCL, p=.001). Women who had KCL reported more pain in the period between feticide and dilator placement and the evacuation than women who had not received feticide (49% vs. 25%, respectively, p<.001). Most women in both groups found their procedure very acceptable or acceptable (79% KCL vs. 87% no-KCL, p=.2). ConclusionsFeticide with intra-cardiac KCL reduced D&E procedure duration, but was associated with more pain and uterine atony. Treatment acceptability was high with and without feticide.Implications.Inducing fetal demise before dilation and evacuation with intra-cardiac potassium chloride may result in shorter operative times but does not appear to improve safety or acceptability. Level I evidence remains needed to support the use of feticide before surgical abortion.

Intrafetal laser ablation for embryo reduction from dichorionic triplets to dichorionic twins.

To report the outcome of dichorionic (DC) triplet pregnancies reduced to DC twins by laser ablation of the pelvic vessels of one of the monochorionic (MC) twins. Intrafetal laser embryo reduction (ER) from DC triplets to DC twins was carried out in 61 pregnancies at 11 + 0 to 14 + 3 weeks' gestation. Pregnancy outcome was examined. Intrafetal laser was successfully carried out in all cases, but ultrasound examination within 2 weeks of the procedure demonstrated that the MC cotwin had died in 28 (45.9%) cases and was alive in the other 33 (54.1%). In the DC group, there was one miscarriage at 23 weeks, one neonatal death after delivery at 26 weeks and in the other 31 cases there were two live births at a median gestational age of 35.3 (range, 30.4-38.4) weeks. In the 28 cases in which both MC fetuses died, there was one miscarriage at 16 weeks and in the other 27 cases the separate triplet was liveborn at a median gestation of 38.2 (range, 32.2-42.1) weeks. The overall rate of miscarriage was 3.3% (2/61) and that of preterm birth (PTB) at < 33 weeks was 6.8% (4/59). In the management of DC triplet pregnancies, ER to DC twins by intrafetal laser ablation is associated with lower rates of miscarriage or early PTB, compared with expectant management or ER by fetal intracardiac injection of potassium chloride. However, about half of the pregnancies result in the birth of one rather than two babies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Selective Termination for Fetal Anomaly in Twin Pregnancy

Objective: To discussed the ethical aspects, the technique, optimal timing and the possible outcome of selective termination in anomalous twin pregnancy.&#x0D; &#x0D; Case description: A 28-year old primigravida, 21 weeks twin gestation, with giant hygroma coli in one fetus. The normal fetus was compressed by the anomalous fetus with oligohydramnios. The parent decided to undergo selective termination of the abnormal fetus. The procedure perform was intracardiac injection of potassium chloride&#x0D; (KCl). Eight milliliters of KCl were injected into fetal cardiac, followed by bradicardia and asystole of the anomalous twin. A week after the procedure, the normal fetus also died and delivered spontaneously after induction.&#x0D; &#x0D; Conclusion: Selective termination for fetal anomaly in twin pregnancy have some aspects to be considered.&#x0D; &#x0D; [Indones J Obstet Gynecol 2013; 37-1: 57-60]&#x0D; &#x0D; Keywords: selective feticide, selective termination

Management of very early preterm premature rupture of membranes (PPROM) in twin pregnancies by selective feticide

Abstract Aim: To assess the efficacy of selective termination in improving pregnancy outcome in very early preterm premature rupture of membranes (PPROM) in twin pregnancies. Methods: A total of six dichorionic twin intracytoplasmic sperm injection (ICSI) pregnancies complicated with very early PPROM between 17+5 and 19+3 gestational weeks were admitted to our hospital and were managed by selective termination of the member with ruptured membranes and followed up. Two cases were twins reduced from triplets at our unit (33%). The fetuses with ruptured membranes were subjected to feticide by intra-cardiac injection of potassium chloride after a mean of 3.5 days following PPROM. Results: The overall PPROM-delivery/miscarriage time-interval was 80 days using the proposed management scheme. Two cases ended with total pregnancy loss at 21+ and 23+ weeks, respectively. Four cases progressed successfully beyond 29 weeks, reaching an average of 35+5 days. Conclusions: The handling of these six twin PPROM cases as described produced a healthy baby to take home in four instances, resulting in a success rate of 67%, whereas the implementation of a more conservative approach using antibiotics and steroids is expected to lead to a survival rate of around 15% and a handicap rate up to 50%.

Fetal ‘black lung’ on PMMR: Fetocide related?

This fetus underwent late termination of pregnancy (third trimester) for antenatally sonographically diagnosed severe renal tract abnormalities. At PMMR, both kidneys were markedly enlarged, almost 6 cm in length, with a collapsed thick-walled bladder, confirmed to be autosomal recessive polycystic kidney disease at autopsy (not shown). However, we noticed that the right lower lobe demonstrated very low signal on T2-weighted imaging, with a clear lobar distribution (Fig. 1b and e). This has an unusual configuration for most typical perinatal lung parenchymal pathology found in this setting (e.g. congenital pulmonary airway malformation; congenital lobar emphysema). Both right and left lower lobes were resected in their entirety at autopsy, and both had normal and comparable macroscopic (Fig. 1a and c) and microscopic appearances (Fig. 1d and f). We have now encountered this on two occasions, and, in conjunction with intracardiac and pleural gas, we hypothesize that these changes are related to the mode of late termination, with intracardiac injection of potassium chloride, accessed through the right chest wall where the needle may have traversed the right lower lobe with some extravasation of agent into the lung.

Selective termination in discordant twin pregnancy with early onset preeclampsia: case report

Objective: To study the effectiveness of selective termination for discordant twins in treating early onset preeclampsia. Materials and Methods: After literature review, ethical review, and discussion with the couple, one patient with early onset preeclampsia complicated with a lethal condition in one twin, was performed selective termination by intracardiac injection of potassium chloride at 27 weeks’ and four days’ gestation in an effort to reverse preeclampsia and prolong the pregnancy. Results: The clinical manifestation of preeclampsia was alleviated in this patient. At 29 weeks, the stillborn fetus was delivered because of spontaneous preterm labor. A live birth was achieved five days later. All procedures allowed continuation of the pregnancy for an additional two weeks and one day of the remaining fetus. Conclusion: Selective termination may be an option for treating early onset preeclampsia in discordant twins, instead of termination of whole pregnancy.

Anesthesia Literature Review

Anesthesia Literature Review

Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders

To investigate the indications for offering selective fetal reduction in monochorionic (MC) and dichorionic (DC) twins and to correlate obstetric outcome with the antenatal procedure. All cases of MC and DC twins discordant for structural anomalies and for chromosomal/genetic abnormalities were included. Selective reductions performed for twin-to-twin transfusion syndrome or growth restriction were excluded. For DC twins, feticide was achieved using intracardiac injection of potassium chloride (KCl). For MC twins, bipolar cord occlusion (BCO), interstitial laser or radiofrequency ablation (RFA) was used. There were 121 twin pregnancies discordant for structural and chromosomal abnormalities. Only 88 (56 were MC twins and 32 were DC twins) had selective reduction. For both MC and DC twins, the leading indication for selective reduction was structural anomalies with CNS malformations the most common. For all MC fetal reduction techniques, the overall pregnancy loss rate (<24weeks) was 8.9% with RFA having the lowest procedure loss rate (7.7%). The preterm delivery rate was lowest with reduction in DC pregnancies. The live birth rates for MC twins were >87% and 100% for DC twins. Selective reduction in MC pregnancies carries an increased procedure-related and preterm delivery rate compared with DC pregnancies. The main indication for selective reduction was structural malformations, with a predominance of CNS anomalies.