Selective termination for structural, chromosomal, and mendelian anomalies: International experience

OBJECTIVE: Our purpose was to evaluate the outcomes of selective terminatio n for fetal anomalies at 8 centers with the largest known experiences world wide. STUDY DESIGN: Outcomes in 402 cases of selective termination in pregnancies with dizygotic twins from 8 centers in 4 countries were analyzed by year, gestational age at procedure, and indication. Reductions of fetuses were as follows: 2 to 1, n = 345; 3 to 2, 39; greater than or equal to 4 to 2 or 3 , n = 18. Potassium chloride was used in all procedures. RESULTS: Selective termination resulted in delivery of a viable infant or i nfants in >90% of cases. Loss up to 24 weeks occurred in 7.1% of cases in w hich the final result was a singleton fetus and in 13.0% of cases in which the final result was twins. Loss was 6.6% as a result of structural abnorma lities, 7.0% for chromosomal abnormalities, and 10% for mendelian abnormali ties (difference not statistically significant). Loss rates for procedures were as follows: 9-12 weeks, 5.4%; 13-18 weeks, 8.7%; 19-24 weeks, 6.8%; an d greater than or equal to 25 weeks, 9.1% (difference not statistically sig nificant). Mean gestational age at delivery was 35.7 weeks. No differences were seen in outcomes by maternal age. The rate of very early premature del iveries has fallen in recent years. There were no known cases of disseminat ed intravascular coagulation or serious maternal complications. CONCLUSION: (1) Selective termination, in the most experienced hands, can b e technically performed in all 3 trimesters with good outcomes in >90% of c ases. (2) The previously observed increase in second- versus first-trimeste r losses has diminished. (3) Third-trimester procedures, where legal, can b e performed with a good outcome for the surviving fetus.