Selective fetocide reverses preeclampsia in discordant twins
Kent D Heyborne1, Richard P Porreco
1Department of Obstetrics and Gynecology, Swedish Medical Center, Englewood, CO, USA.
Objective:
Preeclampsia occurs in some twin gestations in association with a placental disorder of one but not both fetuses, thereby placing both at risk. We investigated a novel method of treating preeclampsia in these pregnancies.
Study Design:
Three patients with second trimester preeclampsia linked to a lethal condition in one twin were treated with selective fetocide in an effort to reverse preeclampsia. Two patients presented with twins discordant for severe fetal growth restriction, and 1 patient presented with Ballantyne syndrome and twins discordant for fetal hydrops.
Results:
Preeclampsia resolved in all 3 patients, allowing continuation of the pregnancy for an additional 9 to 23 weeks before delivery of the remaining fetus. Resolution of preeclampsia occurred in a timeframe consistent with placental involution documented in similar clinical circumstances.
Conclusion:
Selective fetocide may be an option for treating preeclampsia in some twin pregnancies, presumably by causing involution of the pathologic placenta. Delivery is not the only cure for preeclampsia.
