title: Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center.
abstract: OBJECTIVE
  To review the experience of performing selective feticide with bipolar cord coagulation (BCC) in complicated monochorionic (MC) twin pregnancies at a single center.
  
  
  METHODS
  This was a retrospective analysis of BCC performed using 3-mm bipolar forceps under ultrasound control in cases complicated by twin-to-twin transfusion syndrome, selective growth restriction, discordant anomaly or twin reversed arterial perfusion sequence.
  
  
  RESULTS
  The series comprised 118 cases with a median gestational age at the time of the procedure of 22 (range, 16-30) weeks. There were 14 (12%) intrauterine deaths of the cotwin, eight (7%) miscarriages and one (1%) termination of pregnancy. When BCC was performed before 19 weeks of gestation, the rate of miscarriage was 45%, whereas it was 3% (P < 0.001) when BCC was performed after 19 weeks. Preterm prelabor rupture of membranes (PPROM) occurred in 45 (38%) cases. The median interval between BCC and PPROM was 4 (interquartile range, 2-9) weeks. In 15 (13%) cases, PPROM occurred within 2 weeks after the procedure. Median gestational age at delivery was 34 (range, 24-41) weeks. The median birth weight was 2103 (range, 480-3875) g. Neonatal death occurred in 11 (9%) cases, and two (2%) children had severe neurologic morbidity. The overall survival rate was 71% (84/118).
  
  
  CONCLUSIONS
  BCC is an effective procedure in complicated MC twin pregnancies for selective feticide or when one fetus is severely jeopardized and delivery is not yet an option. Better outcomes can be achieved when this procedure is performed after 19 weeks.
authors.affiliation: Department of Obstetrics and Gynecology, Children's Hospital V. Buzzi, Milan, Italy. marianomatteo.lanna@fastwebnet.it
authors.forename: M M
authors.initials: MM
authors.lastname: Lanna
authors.forename: M A
authors.initials: MA
authors.lastname: Rustico
authors.forename: M
authors.initials: M
authors.lastname: Dell'Avanzo
authors.forename: V
authors.initials: V
authors.lastname: Schena
authors.forename: S
authors.initials: S
authors.lastname: Faiola
authors.forename: D
authors.initials: D
authors.lastname: Consonni
authors.forename: A
authors.initials: A
authors.lastname: Righini
authors.forename: B
authors.initials: B
authors.lastname: Scelsa
authors.forename: E M
authors.initials: EM
authors.lastname: Ferrazzi
mesh_terms: D000650:Amnion / Q000601:surgery; D002823:Chorion / Q000601:surgery; D004200:Diseases in Twins / Q000401:mortality; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods* / Q000523:psychology; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D012307:Risk Factors; D014430:Twins, Monozygotic; D014470:Umbilical Cord / Q000601:surgery*