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Selective delivery in a twin gestation

R P Porreco1, E D Sabin, K D Heyborne

  • 1Columbia Presbyterian/St. Luke's Medical Center, Denver, Colorado 80218, USA.

American Journal of Obstetrics and Gynecology
|August 15, 1998
PubMed
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Selective delivery can be an option for multifetal pregnancies when one twin faces in utero death risk. This case highlights selective delivery for a growth-restricted twin in a dichorionic gestation.

Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • Neonatalogy

Background:

  • Multifetal pregnancies carry risks, including selective fetal reduction when one fetus is at high risk of demise.
  • Selective delivery is a complex decision-making process balancing risks between fetuses.

Observation:

  • A dichorionic twin gestation at 26 weeks 5 days presented with one fetus showing growth restriction (650g), low amniotic fluid, and concerning umbilical artery Doppler findings.
  • The normally grown sibling fetus exhibited reassuring surveillance data.
  • The growth-restricted twin demonstrated no interval growth and clinical deterioration over two weeks.

Findings:

  • Selective delivery via hysterotomy was performed on the compromised twin.
  • This intervention aimed to improve outcomes for the remaining fetus and potentially the family.

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Implications:

  • Selective delivery offers a potential management strategy for high-risk fetuses in multifetal gestations.
  • This approach may provide parents with an additional option to consider in complex pregnancy scenarios.
  • Further research is needed to establish optimal protocols and long-term outcomes for selective delivery.