Pediatric outcome after selective feticide for 30 complicated monochorionic twin pregnancies [Suivi pédiatrique de 30 grossesses gémellaires monochoriales consécutives traitées par f?ticide sélectif]

摘要

Objectives: To describe perinatal and pediatric outcome after selective feticide for complicated monochorionic twin pregnancy. Patients and methods: We reviewed all consecutive cases of umbilical cord occlusion performed for complicated monochorionic twin pregnancy over a 16-year period. Pediatric follow-up was based on medical records and updated by phone calls to the parents. Results: Thirty procedures were performed. Indications were: twin-to-twin transfusion syndrome (TTTS) progressing despite serial amniodrainage (n = 12) ; twin reversed arterial perfusion (n = 9) ; selective growth restriction (n = 5) ; severe discordant structural anomalies (n = 4). Mean gestational age at procedure was 21.8 ± 3.1 gestational weeks (GW) and 31.8 ± 4.8 GW at birth. Overall survival rate was 87%, i.e. 83%, 100%, 60% and 100% for each indication, respectively. Mean pediatric follow-up was 5 years (range: 6 months to 15 years). Medical charts and parents declared normal development in 88% of surviving children, i.e. 67%, 100%, 100%, and 100% for each indication. Cross-comparison between the four groups revealed that in the TTTS group, gestational age at procedure was more advanced (P = 0.01) while delivery was slightly earlier (P = 0.1), and pediatric development was poorer (P = 0.02). Discussion and conclusion: Pediatric outcome after selective feticide appeared to be poorer for TTTS progressing despite serial amniodrainage than for other indications.