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Am J Perinatol 2014; 31(S 01): S51-S58
DOI: 10.1055/s-0034-1383852
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Selective Reduction in Complex Monochorionic Gestations

Michael Bebbington
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
2   The Texas Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas
› Author Affiliations
Further Information

Publication History

17 April 2014

01 May 2014

Publication Date:
31 July 2014 (online)

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Abstract

The early determination of chorionicity in twin gestations is a critical factor in the management of twin gestations. While twins and higher order multiple gestations have increased risks of almost any complication of pregnancy, those pregnancies involving a monochorionic (MC) twin pair are at an especially high risk. The presence of vascular anastomoses within a MC placenta creates risk for discordant malformations, twin reversed arterial perfusion sequence, twin-to-twin transfusion syndrome, or severe selective intrauterine growth restriction. While selective reduction of higher order multiple pregnancies is performed to reduce pregnancy-related risks and improve overall outcomes, selective reduction is also an important management strategy in situations where MC pregnancies develop complex complications. This procedure can be lifesaving for the cotwin by preventing intrauterine demise or extreme prematurity. There are several techniques that can be considered, each with its own advantages and disadvantages.

Keywords

bipolar cord coagulation - radiofrequency ablation - complicated monochorionic twin pregnancy - discordant fetal anomalies - selective feticide - selective growth restriction - twin-to-twin transfusion syndrome
 

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