doiSerbia

Selective fetal termination in monochorionic twin pregnancies - pregnancy outcome after bipolar cord coagulation and interstitial laser coagulation

Mandić-Marković Vesna (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Clinic for Gynecology and Obstetrics Narodni Front, Belgrade, Serbia)
Miković Željko (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Clinic for Gynecology and Obstetrics Narodni Front, Belgrade, Serbia)
Filimonović Dejan (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + University Clinic for Gynecology and Obstetrics Narodni Front, Belgrade, Serbia)

Introduction/Objective. In this paper we present the perinatal outcome after selective fetal termination (SFT) in monochorionic (MH) twins done by bipolar cord coagulation (BCC) and interstitial laser coagulation (ILC). Methods. During a five-year period, SFT was done in 22 MH twins. BCC was done in 15 and ILC in seven cases. We registered the indication for SFT, gestational age at SFT, immediate postoperative death and late death of the co-twin, PPROM (preterm pre-labor rupture of membranes), gestational age at delivery/abortion, procedure-to-delivery interval, mode of delivery, neonatal body weight and 5-minute Apgar score. Results. Live birth was significantly higher after BCC than after ILC (86.7:57.1%). Gestational age at intervention was higher in BCC (20.2 ± 1.8 : 16.5 ± 1.7 weeks). Gestational age at delivery/abortion was lower for ILC (32.5 ± 4.8 : 27.5 ± 9.5 weeks); however, there was no difference when comparing live births only (33.8 ± 3.7 : 34.7 ± 4.5 weeks). There was no difference between procedure-to-delivery/abortion interval (86.7 ± 33.7 : 77.1 ± 73 days); however, the interval was significantly higher after ILC when comparing live births only (93.3 ± 33 : 133 ± 30.9 days). There was no difference in PPROM (26.7:14.3%); preterm delivery (69.2:50%); Cesarean section rate (84.6:75%); neonatal body weight (2174 ± 82.4 : 2475 ± 823 g); or Apgar score (7.7 ± 1.9 : 9.2 ± 1). Conclusion. There is no ideal method of SFT in MH twins. Success of each SFT method depends upon the correctly set indication, gestational age at the procedure, and the SFT technique. The risk of co-twin death is lower after BCC than after ILC. As in Narodni Front University Clinic for Gynecology and Obstetrics better results were achieved after BCC, this method became a standard for SFT in MH twins, except in cases of twin reversed arterial perfusion sequence before 16 weeks.

Keywords: selective fetal termination, monochorionic twins, bipolar cord coagulation, interstitial laser coagulation