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Updated: Jun 4, 2025

Guide Wire Assisted Catheterization and Colored Dye Injection for Vascular Mapping of Monochorionic Twin Placentas
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Selective termination: a life-saving procedure for complicated monochorionic gestations.

Ali Javinani1, Ramesha Papanna2, Tim Van Mieghem3,4

  • 1Fetal Care and Surgery Center (FCSC), Division of Fetal Medicine and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Journal of Perinatal Medicine
|December 24, 2024
PubMed
Summary
This summary is machine-generated.

Selective termination in monochorionic twin pregnancies can save a healthy fetus when one twin faces intrauterine death. This procedure aims to maximize the surviving twin's health and life, especially when interventions fail.

Keywords:
discordant fetal anomalypost-Dobbsselective fetal growth restrictionselective fetal reductionselective fetal terminationselective feticide

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Area of Science:

  • Perinatology
  • Fetal Medicine
  • Maternal-Fetal Medicine

Background:

  • Monochorionic twin pregnancies share placental vasculature, increasing risks.
  • Anastomotic vessels can cause severe complications, including massive blood shift if one twin dies.
  • This blood shift jeopardizes the surviving twin's life and neurodevelopmental outcome.

Purpose of the Study:

  • To discuss the implications of intrauterine death in monochorionic twins.
  • To highlight the ethical obligations of obstetricians in managing such cases.
  • To advocate for selective termination as a viable option to improve outcomes for the surviving twin.

Main Methods:

  • Review of complications in monochorionic twin pregnancies.
  • Analysis of scenarios where fetal interventions are ineffective.
  • Ethical considerations regarding patient autonomy and beneficence.

Main Results:

  • Intrauterine death in one twin leads to a critical blood shift affecting the co-twin.
  • Conditions like selective fetal growth restriction and twin-twin transfusion present significant risks.
  • Fetal interventions may be ineffective in preventing adverse outcomes in these complex cases.

Conclusions:

  • Selective termination is a strategy to maximize the health of the surviving twin.
  • Obstetricians must balance patient autonomy with beneficence for both fetuses.
  • Policy considerations should include selective termination as an exemption in abortion bans.