[Foeto-foetal conflict of interests in multiple pregnancies with severe discordant growth; ethical dilemmas].
Two pregnant women, 19 and 26 years old, presented at the beginning of the third trimester with one growth-retarded foetus in a multiple pregnancy. Both cases were managed conservatively. In the first woman, one foetus died at 30 weeks of gestation, after the mother developed pre-eclampsia. After the death of the impaired foetus pre-eclampsia resolved and the second child was born healthy at 36 weeks of gestation. The second woman had triplets with one severely growth-retarded foetus. This foetus died at 3I weeks of gestation. At 33 & 317 weeks, caesarean section was performed on both maternal and foetal indications. Two healthy premature neonates were born. In multiple pregnancy with discordant growth, the interests of the foetuses may be in opposition, which creates an ethical dilemma. This may be resolved by carefully addressing the interests of all those involved and keeping in mind the prognosis, duration of pregnancy and the best interests of the healthy foetus, which should not be harmed by intervention. Therefore, active intervention is not always the best option; the least harm it does is increasing the risk ofpreterm birth.
Leids Universitair Medisch Centrum, afd. Verloskunde en Gynaecologie, Leiden.
M A
MA
de Boer
J C M
JC
van Huisseling
J
J
van Roosmalen
D000328:Adult; D026690:Ethics, Clinical; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005317:Fetal Growth Retardation / Q000150:complications*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000941:ethics; D011272:Pregnancy, Multiple