Improving pregnancy outcome in twin gestations with one malformed fetus by postponing selective feticide in the third trimester.
OBJECTIVE
To examine the course of pregnancy and fetal outcome in patients with twin gestations in which one abnormal fetus underwent selective feticide in the third trimester of pregnancy.


METHODS
A study of 23 consecutive late selective feticide procedures.


METHODS
Department of Obstetrics and Gynecology, Rabin Medical Center, Israel.


METHODS
Twenty-three patients with twin pregnancies with one malformed fetus.


METHODS
Selective feticide with intracardiac injection of KCl was performed at 28-33 weeks of gestation after the diagnosis of fetal genetic (56.5%) or structural (43.5%) malformations made in the second trimester (18-24 weeks). All procedures were performed at the patient's request and on approval of a committee for fetal termination late in pregnancy. Betamethasone treatment was initiated to enhance lung maturity 3 weeks before selective feticide. All patients were placed on complete bed rest until 35 weeks' gestation.


METHODS
Early and late complications related to the procedure; outcome of pregnancy and fetal survival.


RESULTS
All 23 twin pregnancies had an uneventful course after selective feticide performed at 28-33 weeks. All birth weights were > 2,000 g (mean +/- SD, 2,628 +/- 646 g), indicating an excellent chance of survival.


CONCLUSIONS
Our results suggest that late selective feticide in twin gestations is safe and efficient and results in a favorable outcome for the surviving fetus. This procedure should be performed at 28-30 weeks after treatment for enhancement of lung maturity.
Shalev
J
J
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel.
Meizner
I
I
Rabinerson
D
D
Mashiach
R
R
Hod
M
M
Bar-Chava
I
I
Peleg
D
D
Ben-Rafael
Z
Z
D001724:Birth Weight; D002869:Chromosome Aberrations / Q000196:embryology; D025063:Chromosome Disorders; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000196:embryology; D005260:Female; D005307:Fertilization in Vitro; D005333:Fetus / Q000002:abnormalities*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D011263:Pregnancy Trimester, Third; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D014429:Twins, Dizygotic; D016216:Ultrasonography, Prenatal