title: Selective termination in dichorionic twins discordant for congenital defect.
abstract: OBJECTIVE
  To evaluate the perinatal outcome of selective termination in dichorionic twins discordant for congenital defect, performed at the Hospital General Universitario Gregorio Marañon.
  
  
  METHODS
  Twenty-eight dichorionic twins with an anomalous fetus were included from May 2008 to February 2011. Intracardiac KCl (1-2 ml; 15 mEq/ml) under ultrasonographic guidance was used in all procedures. Congenital defect, gestational age at the procedure, incidence and perinatal outcome were retrieved.
  
  
  RESULTS
  Selective termination was performed in 14 (50%) cases of structural defects with normal karyotype and in 14 (50%) cases of chromosomal abnormality, 13 of them (92.8%) trisomy 21. Median gestational age at the procedure was 17.8 weeks (range 14.5-24; SD 2.3), and 12 (42.8%) were performed before 18 weeks. The presenting fetus was terminated in 11 cases (39.3%). Selective termination was followed by the subsequent delivery of a viable infant in 27 out of 28 cases (96.4%). Fetal loss before 24 weeks occurred in 1 case (3.6%). Median gestational age at delivery was 38 weeks (range 24.1-40.1; SD 3.8). Twenty-four (88.9%) were delivered >34 weeks and 1 (3.7%) before 28 weeks.
  
  
  CONCLUSIONS
  Selective termination in dichorionic twins discordant for congenital defect is a safe procedure with low risk of unintended fetal loss. This option is a reasonable alternative to expectant management or termination of the whole pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Fetal Medicine Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. eantolin.hgugm@salud.madrid.org
authors.forename: Eugenia Antolín
authors.initials: EA
authors.lastname: Alvarado
authors.forename: Ricardo Pérez Fernández
authors.initials: RP
authors.lastname: Pacheco
authors.forename: Francisco Gámez
authors.initials: FG
authors.lastname: Alderete
authors.forename: Juán Antonio de León
authors.initials: JA
authors.lastname: Luís
authors.forename: Angel Aguarón
authors.initials: AA
authors.lastname: de la Cruz
authors.forename: Luís Ortiz
authors.initials: LO
authors.lastname: Quintana
mesh_terms: D000328:Adult; D025063:Chromosome Disorders; D000013:Congenital Abnormalities; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007267:Injections; D011189:Potassium Chloride / Q000008:administration & dosage; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D014429:Twins, Dizygotic
chemical_list: D011189:Potassium Chloride