Successful selective termination at 17 weeks' gestation in monochorionic monoamniotic twin pregnancy affected by twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome

• Published in: Prenatal diagnosis 2005-12, Vol.25 (13), p.1223-1225
• Main Authors: del Río, Maria, Martínez, Josep Maria, Galindo, Alberto, Figueras, Francesc, Palacio, Montse, Borrell, Antoni, Puerto, Bienvenido, Coll, Oriol, de la Fuente, Pedro
• Format: Article
• Language: English
• Subjects: Adult; Amniotic Fluid; Biological and medical sciences; bipolar diathermy; Cardiology. Vascular system; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; cord occlusion; Female; Fetal Diseases - diagnostic imaging; Fetal Diseases - surgery; Fetofetal Transfusion - diagnostic imaging; Fetofetal Transfusion - surgery; fetoscopy; Gynecology. Andrology. Obstetrics; Heart; Humans; Hypoplastic Left Heart Syndrome - diagnostic imaging; Hypoplastic Left Heart Syndrome - embryology; Hypoplastic Left Heart Syndrome - surgery; Management. Prenatal diagnosis; Medical sciences; monoamniotic twins; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal - methods; Pregnancy, Multiple; Pregnancy. Fetus. Placenta; selective feticide; Twins, Monozygotic; Ultrasonography, Interventional - methods; Ultrasonography, Prenatal; Umbilical Cord - surgery
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.1306

Objectives To report a successful selective feticide in a complicated monochorionic monoamniotic (MCMA) pregnancy. Methods A case of MCMA pregnancy with severe twin–twin transfusion syndrome and discordant for hypoplastic left heart syndrome was diagnosed at 16 weeks' gestation. A complete ultrasound and fetoscopic surveillance was performed, ruling out cord entanglement and, thus, precluding the necessity of transecting the cord. Results The selective feticide was successfully performed by bipolar coagulation of the umbilical cord of the abnormal fetus under ultrasound guidance. The survivor twin developed normally during the rest of the pregnancy and was born at term. At 6 months of age, the infant was healthy. Conclusion Selective feticide in complicated monoamniotic pregnancies can be safely performed. Cord entanglement can be confidently excluded by both ultrasound and fetoscopy, thus making the systematic transection of the umbilical cord unnecessary. Copyright © 2005 John Wiley & Sons, Ltd.