Selective termination: a life-saving procedure for complicated monochorionic gestations

Monochorionic twin pregnancies are a subset of twin pregnancies that face potential complications related to a shared circulation between the fetuses. These complications are related to anastomotic placental vessels connecting the cardiovascular systems of the two fetuses, which can result in significant sequela if one twin experiences intrauterine death. The sudden cardiovascular collapse in this scenario leads to a massive blood shift away from the healthy co-twin, significantly jeopardizing its life and long-term neurodevelopmental outcome. Such conditions include selective fetal growth restriction with abnormal Doppler findings, twin-twin transfusion with impending death in one twin and discordant fetal anomalies, for which fetal interventions are ineffective in improving outcomes or preventing the imminent death of the abnormal twin. Obstetricians have a professional obligation to respect the autonomy of pregnant patients and to maximize beneficence-based obligations to both pregnant and fetal patients. The goal of a selective termination is to maximize the health and life of the surviving fetal patient. It is recommended that policymakers consider including selective termination as an exemption to abortion ban laws.