100 CONSECUTIVE CASES OF SELECTIVE TERMINATION OF AN ABNORMAL FETUS IN A MULTIFETAL GESTATION

Objective: To determine whether transabdominal selective termination o f one or more abnormal fetuses in a multifetal pregnancy with dichorio nic placentation is a safe and effective procedure. Methods: One hundr ed consecutive selective termination procedures were performed by tran sabdominal injection of potassium chloride into the heart or umbilical vein of an anomalous fetus in a multifetal pregnancy. All of the abno rmal fetuses were presumed to have dichorionic diamniotic placentas, b ased on an ultrasound evaluation before the procedure. Follow-up data were obtained for each patient regarding the development of postproced ural complications, laboratory or clinical evidence of a coagulopathy, maternal or neonatal morbidity, gestational age at delivery, and birt h weight of the infants. Results: Ninety-one sets of twins were reduce d to singletons, six sets of triplets were reduced to twins, two sets of triplets were reduced to singletons, and one set of quadruplets was reduced to triplets. The anomalous fetus or fetuses were identified c orrectly and terminated in each case. Three patients spontaneously abo rted, and one woman electively terminated her pregnancy 2 weeks after the procedure. The mean gestational age at delivery of the 96 patients who delivered surviving infants was 36.8 weeks, and 85.4% delivered a t 32 weeks or later. Three women developed laboratory evidence of a co agulopathy, but there were no cases of clinically Evident disseminated intravascular coagulation.Conclusion: This procedure, performed at a single institution by a small number of operators using a common proto col, accomplished its objective in all cases, was accompanied by a low spontaneous loss rate, and resulted in the birth of healthy infants a t or near term in the vast majority of cases. This series suggests tha t selective termination is a reasonable option to consider when one ab normal fetus is found in a multifetal pregnancy with dichorionic place ntation. (C) 1997 by The American College of Obstetricians and Gynecol ogists.