Selective termination: a life-saving procedure for complicated monochorionic gestations.

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Ali Javinani, Ramesha Papanna, Tim Van Mieghem, Julie S Moldenhauer, Anthony Johnson, Enrico Lopriore, Amos Grünebaum, Frank A Chervenak, Alireza A Shamshirsaz
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引用次数: 0

Abstract

Monochorionic twin pregnancies are a subset of twin pregnancies that face potential complications related to a shared circulation between the fetuses. These complications are related to anastomotic placental vessels connecting the cardiovascular systems of the two fetuses, which can result in significant sequela if one twin experiences intrauterine death. The sudden cardiovascular collapse in this scenario leads to a massive blood shift away from the healthy co-twin, significantly jeopardizing its life and long-term neurodevelopmental outcome. Such conditions include selective fetal growth restriction with abnormal Doppler findings, twin-twin transfusion with impending death in one twin and discordant fetal anomalies, for which fetal interventions are ineffective in improving outcomes or preventing the imminent death of the abnormal twin. Obstetricians have a professional obligation to respect the autonomy of pregnant patients and to maximize beneficence-based obligations to both pregnant and fetal patients. The goal of a selective termination is to maximize the health and life of the surviving fetal patient. It is recommended that policymakers consider including selective termination as an exemption to abortion ban laws.

选择性终止妊娠:复杂单绒毛膜妊娠的救命程序。
单绒毛膜双胎妊娠是双胎妊娠的一个子集,面临与胎儿之间共享循环相关的潜在并发症。这些并发症与连接两个胎儿心血管系统的胎盘吻合血管有关,如果双胞胎中的一个经历宫内死亡,可能会导致严重的后遗症。在这种情况下,突然的心血管衰竭会导致大量血液从健康的同卵双胞胎中流出,严重危及其生命和长期的神经发育结果。这些情况包括选择性胎儿生长受限伴异常多普勒检查结果,双胎输血伴其中一个即将死亡,以及不协调胎儿异常,胎儿干预对改善结果或防止异常双胞胎即将死亡无效。产科医生有专业义务尊重怀孕患者的自主权,并最大限度地为孕妇和胎儿患者提供基于利益的义务。选择性终止妊娠的目的是最大限度地保证存活胎儿的健康和生命。建议决策者考虑将选择性终止妊娠作为堕胎禁令的豁免。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Perinatal Medicine
Journal of Perinatal Medicine 医学-妇产科学
CiteScore
4.40
自引率
8.30%
发文量
183
审稿时长
4-8 weeks
期刊介绍: The Journal of Perinatal Medicine (JPM) is a truly international forum covering the entire field of perinatal medicine. It is an essential news source for all those obstetricians, neonatologists, perinatologists and allied health professionals who wish to keep abreast of progress in perinatal and related research. Ahead-of-print publishing ensures fastest possible knowledge transfer. The Journal provides statements on themes of topical interest as well as information and different views on controversial topics. It also informs about the academic, organisational and political aims and objectives of the World Association of Perinatal Medicine.
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