Improving pregnancy outcome in twin gestations with one malformed fetus by postponing selective feticide in the third trimester

Objective: To examine the course of pregnancy and fetal outcome in patients with twin gestations in which one abnormal fetus underwent selective feticide in the third trimester of pregnancy. Design: A study of 23 consecutive late selective feticide procedures. Setting: Department of Obstetrics and Gynecology, Rabin Medical Center, Israel. Patient(s): Twenty- three patients with twin pregnancies with one malformed fetus. Intervention(s): Selective feticide with intracardiac injection of KCl was performed at 28-33 weeks of gestation after the diagnosis of fetal genetic (56.5%) or structural (43.5%) malformations made in the second trimester (18- 24 weeks). All procedures were performed at the patient's request and on approval of a committee for fetal termination late in pregnancy. Betamethasone treatment was initiated to enhance lung maturity 3 weeks before selective feticide. All patients were placed on complete bed rest until 35 weeks' gestation. Main Outcome Measure(s): Early and late complications related to the procedure; outcome of pregnancy and fetal survival. Result(s): All 23 twin pregnancies had an uneventful course after selective feticide performed at 28-33 weeks. All birth weights were >2,000 g (mean ± SD, 2,628 ± 646 g), indicating an excellent chance of survival. Conclusion(s): Our results suggest that late selective feticide in twin gestations is safe and efficient and results in a favorable outcome for the surviving fetus. This procedure should be performed at 28-30 weeks after treatment for enhancement of lung maturity.