[Selective termination of pregnancy for monochorionic twins: a national survey of professional practice].
OBJECTIVE
Selective Termination of Pregnancy (STOP) for discordant fetal condition in monochorionic twin pregnancy is a rarely performed procedure raising technical and ethical considerations. There are no epidemiological data available in France concerning STOP and no guideline or scientific consensus on how or when to perform has been published.


METHODS
We conducted a study of national practice using a declarative questionnaire sent by e-mail to each medical coordinator of every 48 Multidisciplinary Center for Prenatal Diagnosis in France. The questions focused on the issues of 2010 and 2011. Two reminders were sent in case of no answer.


RESULTS
The response rate to the questionnaire was 56 %; 81 % of centers have experienced at least once during the two years 2010-2011 a discordant fetal anomaly in monochorionic twin pregnancy. Only 59 % of centers perform all the techniques of STOP. When interruption of the umbilical blood flow is considered, bipolar forceps coagulation is the most used (75 %). Achieving STOP during a cesarean section is a common practice (75 % of centers). Locoregional anesthesia is the preferred mode of anesthesia for STOP.


CONCLUSIONS
STOP on monochorionic twin pregnancy is not practiced in all Multidisciplinary Center for Prenatal Diagnosis in France. The most widely practiced and most studied technique is bipolar forceps coagulation. The option of an expectant management should always be considered and its risks should be balanced with those of STOP. The practice of STOP during cesarean section is not unusual.
Médecine et biologie de la reproduction, pôle de gynécologie-obstétrique - médecine fœtale, centre Olympe de Gouges, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France. Electronic address: c.arlicot@chu-tours.fr.
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Arlicot
Médecine et biologie de la reproduction, pôle de gynécologie-obstétrique - médecine fœtale, centre Olympe de Gouges, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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Potin
Médecine et biologie de la reproduction, pôle de gynécologie-obstétrique - médecine fœtale, centre Olympe de Gouges, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France; Inserm U930, faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France.
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Simon
Médecine et biologie de la reproduction, pôle de gynécologie-obstétrique - médecine fœtale, centre Olympe de Gouges, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France; Faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France; Inserm U930, faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France.
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Perrotin
D004200:Diseases in Twins / Q000175:diagnosis; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000601:surgery; D005602:France; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000941:ethics / Q000379:methods* / Q000706:statistics & numerical data*; D059285:Pregnancy, Twin; D011296:Prenatal Diagnosis; D011795:Surveys and Questionnaires; D014427:Twins; D014470:Umbilical Cord
Anomalies fœtales discordantes; Bipolar forceps coagulation; Cesarean section; Coagulation bipolaire; Coagulation laser; Césarienne; Discordant fetal anomalies; Grossesse monochoriale; Interruption sélective de grossesse; Laser coagulation; Monochorionic twin pregnancy; Selective termination of pregnancy