ABSTRACT

OBJECTIVE:

We aimed to evaluate perinatal outcome of selective fetocide in monochorionic diamniotic (MCDA) twins discordant for major fetal anomalies.

MATERIALS-METHOD:

Study group included nine cases of MCDA twin (triplet) pregnancies discordant for major fetal anomalies; anencephaly (n: 2), inencephaly (n: 1), lumbar meningomyolocele (n: 1), hidrops fetalis (n: 1), acardiac twin (n: 2), twin-to-twin transfusion syndrome (stage III, n: 1) and monochorionic triamniotic triplet discordant for anencephaly (n: 1). For bipolar coagulation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm bipolar forcep. The procedures were performed under the guidance of transabdominal ultrasonography.

RESULTS:

The mean gestational age of the cases at intervention and at delivery were 20 weeks (R: 16-24) and 34 weeks (R: 22-38), respectively. The procedure of bipolar coagulation was carried out in mean 20 min (R: 15-40 min.) without maternal complication. One case was aborted at 20 weeks of gestation because of preterm premature rupture of membrane after the procedure. Another case was delivered before 32 weeks, at 28+4 week of gestation, and died at postnatal six month age unrelated to intervention. The other seven cases were delivered after 32 gestational weeks. In eight cases, the procedure were performed without fetal complication. Perinatal outcome as live birth was 88.8% (N: 8/9). Postnatal ages of surviving seven babies were between 8-40 months, and they have been growing up as healthy.

CONCLUSIONS:

Ultrasonographic guided bipolar cord coagulation as a selective fetocide can be succesfully performed to increase the survival rate or prevent morbidity of healthy co-twin in the cases of MCDA (tripelts) discordant major fetal anomalies candidate for selective termination, and should be offered as a choice of prenatal therapy after the parents were informed for intervention or follow up.