Selective termination: a life-saving procedure for complicated monochorionic gestations
Journal of Perinatal Medicine, vol. 53, pp. 305–310
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.
Authors 9
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Boston Children's Hospital · Harvard University
Affiliation as printed
Fetal Care and Surgery Center (FCSC) , Division of Fetal Medicine and Surgery , Boston Children’s Hospital , Harvard Medical School , Boston , MA , USA
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The University of Texas Health Science Center at Houston
Affiliation as printed
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences , UT Health School of Medicine , Houston , TX , USA
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Mount Sinai Hospital · University of Toronto · Sinai Health System
Affiliation as printed
Department of Obstetrics and Gynaecology, Fetal Medicine Unit , Sinai Health System, Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada
Ontario Fetal Centre , Toronto , ON , Canada
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Children's Hospital of Philadelphia
Affiliation as printed
The Center for Fetal Diagnosis and Treatment , The Children’s Hospital of Philadelphia , Philadelphia , PA , USA
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The University of Texas Health Science Center at Houston
Affiliation as printed
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences , UT Health School of Medicine , Houston , TX , USA
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Enrico Lopriore Aachen Division of Neonatology Department of Pediatrics, Willem-Alexander Children's Hospital
Leiden University Medical Center · Willem-Alexander Kinderziekenhuis
Affiliation as printed
Division of Neonatology, Department of Pediatrics , Willem-Alexander Children’s Hospital, Leiden University Medical Center , Leiden , The Netherlands
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Lenox Hill Hospital · Donald & Barbara Zucker School of Medicine at Hofstra/Northwell
Affiliation as printed
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , Lenox Hill Hospital , New York , NY , USA
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Lenox Hill Hospital · Donald & Barbara Zucker School of Medicine at Hofstra/Northwell
Affiliation as printed
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , Lenox Hill Hospital , New York , NY , USA
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Alireza Abdollah Shamshirsaz corresponding
Boston Children's Hospital · Harvard University
Affiliation as printed
Fetal Care and Surgery Center (FCSC) , Division of Fetal Medicine and Surgery , Boston Children’s Hospital , Harvard Medical School , Boston , MA , USA
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