Cord ultrasonic transection procedure for selective termination of a monochorionic twin

Placental vascular communications can present a life-threatening problem in monochorionic twins when one fetus has a lethal anomaly. Although selectiv e feticide is the best option for salvaging the normal twin, techniques nor mally employed (i.e. intracardiac potassium, air embolism) are not prudent given the common circulatory system. Furthermore, in monoamniotic, monochor ionic twin gestations it is important to transect the umbilical cord comple tely to prevent entanglement of the dead fetus around the cord of the norma l twin. We present two cases of monochorionic twins in which the cords were transected with a harmonic scalpel under ultrasonic guidance via one troca r. The harmonic scalpel is an instrument which can simultaneously coagulate and cut blood vessels or tissues. The cord ultrasonic transection procedur e is a novel, minimally invasive technique which offers several advantages over the methods currently used for selective feticide in discordant monoch orionic twin gestations, Copyright (C) 2000 S. Karger AG,Basel.