title: Umbilical cord occlusion for selective feticide in complicated monochorionic twins: a systematic review of literature.
abstract: The aim of this study was to review literature concerning selective feticide (SF) in monochorionic pregnancies complicated with twin-twin transfusion syndrome, twin reversed arterial perfusion, severe malformation, and discordant growth. The remaining twins' outcomes were stratified for indication and surgical technique. Three hundred forty-five cases of SF were reviewed. Premature rupture of membranes was described in all the procedures and complicated 76/345 (22%) pregnancies within 4 postoperative weeks (59%) or later (41%; P = .52). Fetal demise accounted for 51/345 (15%), more frequently within 2 postoperative weeks (79%) than thereafter (21%; P = .004; odds ratio [OR], 6.12; 95% confidence interval [CI], 1.81-20.70). Improved survival rate was achieved in surgeries after 18 weeks (89%) than earlier (69%; P = .02; OR, 0.28; 95% CI, 0.10-0.80) without differences for indication. Survivors were 86% after radiofrequency ablation, 82% after bipolar cord coagulation, 72% after laser cord coagulation, 70% after cord ligation. In spite of favorable outcomes, the optimal surgical approach remains undetermined.
authors.affiliation: IV Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy. acristinarossi@yahoo.it.
authors.forename: A Cristina
authors.initials: AC
authors.lastname: Rossi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: D'Addario
mesh_terms: D004200:Diseases in Twins; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D014427:Twins; D014430:Twins, Monozygotic; D014470:Umbilical Cord / Q000601:surgery*