Background: Feticide was suggested to avoid delivering children with abnormalities. Recently, twin pregnancies have increased. Selective feticide was proposed to achieve a good outcome of pregnancy. This study aimed to evaluate the performance of feticide in twin pregnancy with fetal anomaly. Methods: This was a retrospective study enrolled from 2009 to 2018. A total of 68 pregnancies with fetal anomalies received feticide. Potassium chloride was injected into the left ventricle to induce fetal asystole. Maternal and fetal characteristics of 16 dichorionic twins were documented to compare before and after 24th gestational week. Results: All pregnant women received feticide without any maternal or fetal complication. The reasons for choosing feticide were divided into four groups, including morphologic defect (61.8%), genetic-chromosomal abnormality (30.9%), obstetrical complication (5.9%), and maternal request (1.5%). Mean gestational age at delivery was significantly higher in dichorionic twins who underwent selective feticide before than after 24th gestational week (36.7 vs 33.4, p = 0.04). Conclusion: Intracardiac injection of potassium chloride was effective for feticide and safe for mothers and fetuses. Selective feticide served as an alternative approach for twin pregnancy with fetal anomaly after sufficient discussion.
Background With advanced diagnostic techniques, early identification of fetal anomaly becomes more accurate. However, certain diseases could only be diagnosed in late gestation. Feticide was suggested to avoid delivering children with abnormalities. Recently, twin pregnancies have increased gradually, and so have their complications. Selective feticide was considered to achieve good outcome of pregnancy. This study aimed to evaluate the performance of feticide in twin pregnancy with fetal anomaly. Methods This was a retrospective study enrolled from 2009 to 2018. A total of 68 pregnancies complicated with fetal anomalies received feticide were recorded. Potassium Chloride (KCl) was injected into left ventricle to induce fetal asystole. Monochorionic twin pregnancies were excluded, maternal and fetal characteristics of 16 dichorionic twins were documented to compare the effectiveness of feticide performed before and after 24th gestational week. Results All the pregnant women received feticide smoothly without any maternal complication. The reasons for choosing feticide were divided into four groups, including morphologic defect (61.8%), genetic-chromosomal abnormality (30.9%), obstetrical complication (5.9%) and maternal request (1.5%). Mean gestational age at delivery was significantly higher in dichorionic twins underwent selective feticide before and after 24th gestational week (36.7 vs 33.4, [p < .05]). No fetal loss in twin pregnancy demonstrated a high successful rate of selective feticide. Conclusion Intra-cardiac injection of KCl was effective for feticide and safe for mothers and fetuses. Selective feticide was beneficial to late gestation of dichorionic twin pregnancy. With sufficient discussion with patients, selective feticide served as an alternative approach for twin pregnancy with fetal anomaly.
Purpose of review To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC). Recent findings Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother. Summary Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.
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