SELECTIVE TERMINATION AND ELECTIVE REDUCTION IN TWIN PREGNANCIES - 10YEARS EXPERIENCE AT A SINGLE-CENTER

Selective termination is employed in multifetal pregnancies, in the pr esence of an abnormal fetus, in order to improve the prognosis of the normal fetuses. The term elective reduction is used to describe reduct ion in twin pregnancies for maternal medical conditions, psychological , or socioeconomic reasons. The purpose of this study was to evaluate the factors that influence outcome in such pregnancies. Eighty-two twi n pregnancies underwent selective termination (n = 59) or elective red uction(n = 23) over a 10-year period. Early procedures, performed less than or equal to 14 weeks (n = 31), had a pregnancy loss of 9.7% and a mean procedure-to-loss interval of 4.1 +/- 2.8 weeks; mean birthweig ht was 3299 +/- 395 g in survivors, with a mean gestational age at del ivery of 38.4 +/- 2.3 weeks. In comparison, procedures performed > 14 weeks (n = 51) had a pregnancy loss of 7.8%, with a procedure-to-loss interval of 1.2 +/- 0.6 weeks. Mean birthweight was 2577 +/- 999 g, wi th a mean gestational age at delivery of 35.7 +/- 5 weeks. In conclusi on, outcomes were more favourable among patients who underwent a first trimester procedure. The slight increase in pregnancy loss may be att ributed to a higher than expected rate of spontaneous abortions in the first trimester, as manifested by the higher procedure-to-loss interv al after a first trimester procedure. These facts underscore the impor tance of early detection of fetal abnormalities in twin pregnancies by ultrasonography and chorionic villus sampling.