Selective Feticide in Monochronic Twin Pregnancies Using Fetoscopy-Guided Bipolar Cord Coagulation

To evaluate the perinatal outcomes in complicated monochorionic twin pregnancies undergoing selective feticide using fetoscopy-guided bipolar cord coagulation (BCC). This was a single-centre retrospective cohort study. All consecutive monochronic pregnancies treated with fetoscopy-guided BCC between December 2015 and December 2022 were included. The adverse perinatal outcomes defined as either intrauterine death, neonatal death, preterm prelabour rupture of membranes (PPROM) before 34.0 weeks of gestation, or preterm delivery (PTD) before 32.0 weeks of gestation and the survival rate were analysed based on various indications. A total of 43 consecutive fetoscopy-guided BCC indicated for selective fetal growth restriction (sFGR) (19 cases), discordant anomalies (13 cases), twin–twin transfusion syndrome (7 cases), twin reversed arterial perfusion sequence (3 cases), twin anemia polycythemia sequence (1 case). The overall survival rate was 86.0% (37/43) and the adverse perinatal outcomes rate was 25.6% (11/43). Median gestational age at delivery was 37+1 weeks (interquartile range 34-39 weeks). Median birthweight was 2965g (interquartile range 2210-3300g). The survival rate based on sFGR, discordant anomalies and twin–twin transfusion syndrome was 89.5% (17/19), 76.9% (10/13) and 85.7% (6/7) respectively. Fetoscopy-guided BCC for fetal reduction in complicated monochorionic twin pregnancies achieves a high survival rate. The pregnancy success rate following fetoscopy-guided BCC selective feticide was higher among sFGR group than in the anomaly group.