Preterm delivery after selective termination in twin pregnancies

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• High-Risk Obstetrics

Background:

• Twin pregnancies face higher risks of preterm delivery and adverse outcomes compared to singleton pregnancies.
• Selective termination is a procedure used to manage abnormal fetuses in multifetal gestations.

Purpose of the Study:

• To evaluate the impact of selective termination of an abnormal twin on the incidence of preterm delivery.
• To compare perinatal outcomes based on the timing and characteristics of selective termination.

Main Methods:

• Retrospective analysis of 69 twin pregnancies undergoing selective termination (1987-1994).
• Comparison with singleton (n=42,362) and twin (n=825) pregnancies delivered during the same period.
• Statistical analysis using Chi-squared, Fisher exact test, and logistic regression to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).

Main Results:

• Selective termination of the presenting twin significantly increased risks for delivery before 37 weeks (aOR 4.1) and low birth weight (aOR 3.8) compared to terminating the nonpresenting twin.
• Termination at or after 20 weeks gestation was linked to increased risks of preterm premature rupture of membranes or preterm labor (aOR 3.7).
• Selective termination patients had a lower preterm delivery rate (40%) than twin pregnancies (58%) but higher than singleton pregnancies (10%).

Conclusions:

• Selective termination of the presenting twin after 20 weeks gestation is associated with poorer perinatal outcomes.
• Performing selective termination before 20 weeks or of the nonpresenting twin may offer better perinatal results.
• While selective termination carries risks, it demonstrates improved outcomes compared to continuing untreated twin pregnancies.