Managing twins discordant for fetal anomaly.

Abstract:

:An excess of structural anomalies is observed in twins compared to singletons. Approximately 1-2% of twin pregnancies may face the dilemma of expectant management versus selective termination following diagnosis of an anomaly affecting only one fetus. If the option of selective fetocide is considered, the main variable determining the technique to achieve this aim is chorionicity. In a dichorionic pregnancy, passage of substances from one twin into the circulation of the co-twin is unlikely due to the lack of placental anastomoses, hence KCl can be injected safely into the circulation of the affected twin to produce fetal asystole. In monochorionic twin pregnancies, selective termination needs to be performed by ensuring complete and permanent occlusion of both the arterial and venous flows in the umbilical cord of the affected twin, in order to avoid acute haemorrhage from the co-twin into the dying fetus, which may lead to death or organ damage. Bipolar cord coagulation under ultrasound guidance is associated with approximately 70-80% survival rates.

journal_name

Prenat Diagn

journal_title

Prenatal diagnosis

authors

Rustico MA,Baietti MG,Coviello D,Orlandi E,Nicolini U

doi

10.1002/pd.1260

subject

Has Abstract

pub_date

2005-09-01 00:00:00

pages

766-71

issue

9

eissn

0197-3851

issn

1097-0223

journal_volume

25

pub_type

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