Successful selective termination at 17 weeks' gestation in monochorionic monoamniotic twin pregnancy affected by twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome.
OBJECTIVE
To report a successful selective feticide in a complicated monochorionic monoamniotic (MCMA) pregnancy.


METHODS
A case of MCMA pregnancy with severe twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome was diagnosed at 16 weeks' gestation. A complete ultrasound and fetoscopic surveillance was performed, ruling out cord entanglement and, thus, precluding the necessity of transecting the cord.


RESULTS
The selective feticide was successfully performed by bipolar coagulation of the umbilical cord of the abnormal fetus under ultrasound guidance. The survivor twin developed normally during the rest of the pregnancy and was born at term. At 6 months of age, the infant was healthy.


CONCLUSIONS
Selective feticide in complicated monoamniotic pregnancies can be safely performed. Cord entanglement can be confidently excluded by both ultrasound and fetoscopy, thus making the systematic transection of the umbilical cord unnecessary.
del Río
Maria
M
Department of Obstetrics and Gynecology, ICGON, Hospital Clinic, University of Barcelona, Spain.
Martínez
Josep Maria
JM
Galindo
Alberto
A
Figueras
Francesc
F
Palacio
Montse
M
Borrell
Antoni
A
Puerto
Bienvenido
B
Coll
Oriol
O
de la Fuente
Pedro
P
D000328:Adult; D000653:Amniotic Fluid; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011272:Pregnancy, Multiple; D014430:Twins, Monozygotic; D018084:Ultrasonography, Interventional / Q000379:methods; D016216:Ultrasonography, Prenatal; D014470:Umbilical Cord / Q000601:surgery