Abstract：
Because selective termination for discordant dichorionic twin anomalies carries a risk of pregnancy loss, deferring the procedure until the third trimester can be considered in settings where it is legal.
To determine whether perinatal outcomes were more favorable following deferred rather than immediate selective termination.
A French multicenter retrospective study from 2012 to 2023 on dichorionic twin pregnancies with selective termination for fetal conditions, which were diagnosed before 24 weeks gestation. Pregnancies with additional risk factors for late miscarriage were excluded. We defined 2 groups according to the intention to perform selective termination within 2 weeks after the diagnosis of the severe fetal anomaly was established (immediate selective termination) or to wait until the third trimester (deferred selective termination). The primary outcome was perinatal survival at 28 days of life. Secondary outcomes were pregnancy losses before 24 weeks gestation and preterm delivery.
Of 390 pregnancies, 258 were in the immediate selective termination group and 132 in the deferred selective termination group. Baseline characteristics were similar in both groups. Overall survival of the healthy co-twin was 93.8% (242/258) in the immediate selective termination group vs 100% (132/132) in the deferred selective termination group (P<.01). Preterm birth <37 weeks gestation was lower in the immediate than in the deferred selective termination group (66.7% vs 20.2%; P<.01); preterm birth <28 weeks gestation and <32 weeks gestation did not differ significantly (respectively 1.7% vs 0.8%; P=.66 and 8.26% vs 11.4%; P=.36). In the deferred selective termination group, an emergency procedure was performed in 11.3% (15/132) because of threatened preterm labor, of which 3.7% (5/132) for imminent delivery.
Overall survival after selective termination was high regardless of the gestational age at which the procedure was performed. Postponing selective termination until the third trimester seems to improve survival, whereas immediate selective termination reduces the risk of preterm delivery. Furthermore, deferred selective termination requires an expert center capable of performing the selective termination procedure on an emergency basis if required.
To determine whether perinatal outcomes were more favorable following deferred rather than immediate selective termination.
A French multicenter retrospective study from 2012 to 2023 on dichorionic twin pregnancies with selective termination for fetal conditions, which were diagnosed before 24 weeks gestation. Pregnancies with additional risk factors for late miscarriage were excluded. We defined 2 groups according to the intention to perform selective termination within 2 weeks after the diagnosis of the severe fetal anomaly was established (immediate selective termination) or to wait until the third trimester (deferred selective termination). The primary outcome was perinatal survival at 28 days of life. Secondary outcomes were pregnancy losses before 24 weeks gestation and preterm delivery.
Of 390 pregnancies, 258 were in the immediate selective termination group and 132 in the deferred selective termination group. Baseline characteristics were similar in both groups. Overall survival of the healthy co-twin was 93.8% (242/258) in the immediate selective termination group vs 100% (132/132) in the deferred selective termination group (P<.01). Preterm birth <37 weeks gestation was lower in the immediate than in the deferred selective termination group (66.7% vs 20.2%; P<.01); preterm birth <28 weeks gestation and <32 weeks gestation did not differ significantly (respectively 1.7% vs 0.8%; P=.66 and 8.26% vs 11.4%; P=.36). In the deferred selective termination group, an emergency procedure was performed in 11.3% (15/132) because of threatened preterm labor, of which 3.7% (5/132) for imminent delivery.
Overall survival after selective termination was high regardless of the gestational age at which the procedure was performed. Postponing selective termination until the third trimester seems to improve survival, whereas immediate selective termination reduces the risk of preterm delivery. Furthermore, deferred selective termination requires an expert center capable of performing the selective termination procedure on an emergency basis if required.
摘要：
背景：由于选择性终止（ST）不一致的双胎畸形有妊娠失败的风险，在合法的环境中可以考虑将手术推迟到妊娠晚期。
目的：确定延迟而不是立即ST后围产期结局是否更有利。
方法：2012年至2023年的法国多中心回顾性研究，研究了在24WG之前诊断为胎儿条件的双胎双胎ST。排除具有晚期流产的其他危险因素的妊娠。我们根据诊断出严重胎儿异常后2周内（立即ST）或等到妊娠晚期（延迟ST）的意图定义了两组。主要结果是28天的围产期生存率。次要结局是24周之前的妊娠损失和早产。
结果：在390次怀孕中，即时ST组258例，延迟ST组132例。两组的基线特征相似。即时ST组健康双胎的总生存率为93.8％（242/258），而延迟ST组为100％（132/132）（p<0.01）。早产<37周妊娠率低于延迟ST组(66.7%vs20.2%,p<0.01）；早产<28WG和<32WG没有显着差异（分别为1.7％和0.8％，p=0.66和8.26%对11.4%，p=0.36）。在延期ST组中，11.3％（15/132）因早产威胁而进行了紧急手术，其中3.7%(5/132)用于即将交付。
结论：无论手术的胎龄如何，ST后的总生存率都很高。将ST推迟到妊娠晚期似乎可以提高生存率，而即时ST降低了早产的风险。此外，如果需要，延期ST需要一个能够在紧急情况下执行ST程序的专家中心。
目的：确定延迟而不是立即ST后围产期结局是否更有利。
方法：2012年至2023年的法国多中心回顾性研究，研究了在24WG之前诊断为胎儿条件的双胎双胎ST。排除具有晚期流产的其他危险因素的妊娠。我们根据诊断出严重胎儿异常后2周内（立即ST）或等到妊娠晚期（延迟ST）的意图定义了两组。主要结果是28天的围产期生存率。次要结局是24周之前的妊娠损失和早产。
结果：在390次怀孕中，即时ST组258例，延迟ST组132例。两组的基线特征相似。即时ST组健康双胎的总生存率为93.8％（242/258），而延迟ST组为100％（132/132）（p<0.01）。早产<37周妊娠率低于延迟ST组(66.7%vs20.2%,p<0.01）；早产<28WG和<32WG没有显着差异（分别为1.7％和0.8％，p=0.66和8.26%对11.4%，p=0.36）。在延期ST组中，11.3％（15/132）因早产威胁而进行了紧急手术，其中3.7%(5/132)用于即将交付。
结论：无论手术的胎龄如何，ST后的总生存率都很高。将ST推迟到妊娠晚期似乎可以提高生存率，而即时ST降低了早产的风险。此外，如果需要，延期ST需要一个能够在紧急情况下执行ST程序的专家中心。
