[Bipolar coagulation used in selective feticide of monochorionic twins with one twin anomaly]

Abstract

Objective: To summarize our preliminary experience of selective feticide with bipolar coagulation in complicated monochorionic twins (MCT), and discuss the clinical application of feticide in discordant MCT.

Methods: Three MCT with one twin anomaly, in which 2 had severe twin-twin transfusion syndrome (TTTS), stage IV, and 1 had acardiac twin, were identified in the second trimester of pregnancy. To terminate the abnormal twin and isolate the co-twin's circulation completely, selective feticide was performed by umbilical cord occlusion with bipolar coagulation under guidance of ultrasound and fetoscopy. After each invasive procedure, serial monitoring was performed, including procedural complications, Doppler of fetal middle cerebral artery and umbilical artery. Pregnancies were followed up every 2 weeks for fetal growth until delivery. After birth the placentas and the terminated fetuses were examined.

Result: Cord occlusion was successfully accomplished in all 3 targeted fetuses, at 21, 22 and 24 weeks of gestation respectively. One case with TTTS was complicated with rupture of the membrane in the terminated fetus the 7th day after the procedure, and a healthy baby was born at 32 weeks. The other case with TTTS delivered a boy by cesarean section at 38 weeks. The third case with TRAP is at 35 weeks of gestations and under regular follow-up. Monochorionicity was confirmed by placental examination after delivery, and the effects of bipolar coagulation were observed at the cord of terminated fetuses.

Conclusions: Umbilical cord occlusion with bipolar coagulation is an effective procedure for selective feticide in MCT with one twin anomaly. The outcome of normal fetus can be favorable.