title: Improving pregnancy outcome in twin gestations with one malformed fetus by postponing selective feticide in the third trimester.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Shalev
authors.forename: I
authors.initials: I
authors.lastname: Meizner
authors.forename: D
authors.initials: D
authors.lastname: Rabinerson
authors.forename: R
authors.initials: R
authors.lastname: Mashiach
authors.forename: M
authors.initials: M
authors.lastname: Hod
authors.forename: I
authors.initials: I
authors.lastname: Bar-Chava
authors.forename: D
authors.initials: D
authors.lastname: Peleg
authors.forename: Z
authors.initials: Z
authors.lastname: Ben-Rafael
mesh_terms: 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