title: Incidence and Causes of Intentional Fetal or Neonatal Demise in Twin-Twin Transfusion Syndrome.
abstract: BACKGROUND
  The aim of this study is to evaluate the incidence and causes of intentional fetal and neonatal demise in twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  All TTTS pregnancies managed at our centre between 2000 and 2014 were included. We evaluated incidence and causes of intentional fetal/neonatal demise, defined as termination of pregnancy, selective fetal reduction, or withdrawal of neonatal intensive care.
  
  
  RESULTS
  Intentional fetal/neonatal demise occurred in 9.8% (110/1,122) of fetuses and was due to termination of pregnancy (2.2%), selective fetal reduction (4.2%), or withdrawal of neonatal intensive care (3.4%). Reasons for termination of pregnancy included complications of laser treatment (72.0%), severe fetal anomaly (20.0%), and unwanted pregnancy (8.0%). Reasons for selective fetal reduction were technical difficulties to perform laser surgery (51.1%), fetal complications (38.3%), and parental preference for fetal reduction rather than laser treatment (10.6%). Reasons for withdrawal of neonatal intensive care treatment were severe cerebral injury (47.4%), severe pulmonary complications (15.8%), birth asphyxia (5.3%), multiple complications of TTTS and/or prematurity combined (21.1%), or other (10.5%).
  
  
  CONCLUSIONS
  Intentional fetal or neonatal demise in TTTS occurs frequently and is often due to complications after laser surgery and/or severe (cerebral) injury in affected fetuses or neonates.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Marjolijn S
authors.initials: MS
authors.lastname: Spruijt
authors.forename: Ellen
authors.initials: E
authors.lastname: Tameeris
authors.forename: De-Peng
authors.initials: DP
authors.lastname: Zhao
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.forename: Monique C
authors.initials: MC
authors.lastname: Haak
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005332:Fetoscopy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D053685:Laser Therapy / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
keywords: Cerebral injury; Fetoscopic laser therapy; Selective fetal reduction; Termination of pregnancy; Twin-twin transfusion syndrome; Withdrawal of neonatal intensive care