Perinatal outcomes between immediate vs deferred selective termination in dichorionic twin pregnancies with fetal congenital anomalies: a French multicenter study

• Published in: American journal of obstetrics & gynecology MFM 2024-06, Vol.6 (6), p.101363, Article 101363
• Main Authors: Soussan, Stanley, Egloff, Charles, Peyronnet, Violaine, Winer, Norbert, Weingertner, Anne-Sophie, Rault, Emmanuel, Fuchs, Florent, Quibel, Thibault, Bourgon, Nicolas, Vivanti, Alexandre J., Rosenblatt, Jonathan, Ponzio-Klijanienko, Alice, Dap, Matthieu, Mandelbrot, Laurent, Picone, Olivier
• Format: Article
• Language: English
• Subjects: Abortion, Spontaneous - epidemiology; Abortion, Spontaneous - prevention & control; Adult; Congenital Abnormalities - diagnosis; Congenital Abnormalities - epidemiology; Congenital Abnormalities - prevention & control; dichorionic twin pregnancy; Female; France - epidemiology; Gestational Age; Humans; Infant, Newborn; invasive procedure; late termination of pregnancy; Life Sciences; neonatal survival; Pregnancy; pregnancy loss; Pregnancy Outcome - epidemiology; Pregnancy Reduction, Multifetal - methods; Pregnancy Reduction, Multifetal - statistics & numerical data; Pregnancy Trimester, Third; Pregnancy, Twin; Premature Birth - epidemiology; Premature Birth - prevention & control; Retrospective Studies; selective termination; termination of pregnancy for fetal anomalies; Time Factors; twin pregnancy
• ISSN: 2589-9333; 2589-9333
• DOI: 10.1016/j.ajogmf.2024.101363

[Display omitted] Because selective termination for discordant dichorionic twin anomalies carries a risk of pregnancy loss, deferring the procedure until the third trimester can be considered in settings where it is legal. To determine whether perinatal outcomes were more favorable following deferred rather than immediate selective termination. A French multicenter retrospective study from 2012 to 2023 on dichorionic twin pregnancies with selective termination for fetal conditions, which were diagnosed before 24 weeks gestation. Pregnancies with additional risk factors for late miscarriage were excluded. We defined 2 groups according to the intention to perform selective termination within 2 weeks after the diagnosis of the severe fetal anomaly was established (immediate selective termination) or to wait until the third trimester (deferred selective termination). The primary outcome was perinatal survival at 28 days of life. Secondary outcomes were pregnancy losses before 24 weeks gestation and preterm delivery. Of 390 pregnancies, 258 were in the immediate selective termination group and 132 in the deferred selective termination group. Baseline characteristics were similar in both groups. Overall survival of the healthy co-twin was 93.8% (242/258) in the immediate selective termination group vs 100% (132/132) in the deferred selective termination group (P