Perinatal Outcomes Following Selective Fetal Terminations of Complicated Monochorionic Pregnancies: Experience From a Referral Center in Southern Spain.

Abstract

The objective of this study was to to describe perinatal outcomes in monochorionic twin pregnancies after selective fetal reduction using bipolar cord coagulation (BCC) or interstitial laser ablation (ILA). This retrospective cohort study included monochorionic twin pregnancies requiring selective fetal reduction between 2008 and 2023 at a referral center in Spain. Maternal and perinatal data were collected and analyzed to compare outcomes between BCC and ILA techniques. The primary outcome was the survival of the co-twin, while secondary outcomes included gestational age at delivery, the incidence of PPROM, birth weight and long-term neurodevelopmental outcomes. Eighty-four procedures were performed (30 ILA, 54 BCC). The overall co-twin survival rate was 80%, with BCC showing a higher survival rate (87%) compared to ILA (67%, p = .026). Fetal death before 24 weeks was more common in ILA (30%) than BCC (7.4%, p = .010). The mean gestational age at delivery was lower in BCC (36.6 weeks) than ILA (38.6 weeks, p = .021), and preterm delivery was more frequent in BCC (50%) compared to ILA (14%, p = .005). BCC seems to have a better overall survival than ILA in complicated monochorionic twins' selective terminations. However, we could not clarify whether this difference was due to the technique itself or the different gestational age at the time of the procedure as well as the specific indication.