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Objective <p>To evaluate procedure-related preterm birth (PTB) following third-trimester selective termination (ST) in DC twins and to compare delivery timing with expectantly managed discordant DC twins and non-anomalous DC twins.</p> Methods <p>A retrospective cohort study was conducted of all DC twin pregnancies undergoing third-trimester ST (&gt; 28&#xa0;weeks) at a tertiary care center (2003–2023). Pregnancies were classified as having procedure-related complications (delivery ≤ 4&#xa0;weeks) or uneventful (delivery &gt; 4&#xa0;weeks). Comparator cohorts included expectantly managed discordant DC twins and non-anomalous DC twins. Outcomes included timing of delivery, cumulative incidence of PTB, and risk factor analysis.</p> Results <p>90 women with DC twin pregnancies elected for ST and 85 procedures were completed. Outcome was available for 81 cases; 48 (59.3%) delivered ≤ 4&#xa0;weeks after ST and 33 (40.7%) delivered later. Clinical chorioamnionitis was more common within the group delivered ≤ 4&#xa0;weeks (35.4% vs. 0%; <i>p</i> = 0.001). Cumulative PTB incidence showed accelerated delivery between 32 and 34&#xa0;weeks after ST. Independent risk factors for delivery ≤ 4&#xa0;weeks included polyhydramnios (OR 5.68) and reduction of the presenting fetus (OR 6.51). Comparator cohorts exhibited substantially lower PTB incidence.</p> Conclusion <p>Third-trimester ST in DC twins is associated with high PTB risk, but excellent co-twin survival. The first 4&#xa0;weeks after ST represent a critical vulnerability period, and risk is strongly influenced by identifiable preprocedural factors. These findings support individualized counseling, later scheduling in high-risk pregnancies, should be considered.</p>

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Evaluating the safety and outcomes of third-trimester selective termination in dichorionic twin pregnancies with discordant anomalies—a standardized approach for counseling

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月10日

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  • Adeline Walter,
  • Anne Flöck,
  • Jorge Jiménez-Cruz,
  • Brigitte Strizek,
  • Ulrich Gembruch,
  • Annegret Geipel

摘要

Objective

To evaluate procedure-related preterm birth (PTB) following third-trimester selective termination (ST) in DC twins and to compare delivery timing with expectantly managed discordant DC twins and non-anomalous DC twins.

Methods

A retrospective cohort study was conducted of all DC twin pregnancies undergoing third-trimester ST (> 28 weeks) at a tertiary care center (2003–2023). Pregnancies were classified as having procedure-related complications (delivery ≤ 4 weeks) or uneventful (delivery > 4 weeks). Comparator cohorts included expectantly managed discordant DC twins and non-anomalous DC twins. Outcomes included timing of delivery, cumulative incidence of PTB, and risk factor analysis.

Results

90 women with DC twin pregnancies elected for ST and 85 procedures were completed. Outcome was available for 81 cases; 48 (59.3%) delivered ≤ 4 weeks after ST and 33 (40.7%) delivered later. Clinical chorioamnionitis was more common within the group delivered ≤ 4 weeks (35.4% vs. 0%; p = 0.001). Cumulative PTB incidence showed accelerated delivery between 32 and 34 weeks after ST. Independent risk factors for delivery ≤ 4 weeks included polyhydramnios (OR 5.68) and reduction of the presenting fetus (OR 6.51). Comparator cohorts exhibited substantially lower PTB incidence.

Conclusion

Third-trimester ST in DC twins is associated with high PTB risk, but excellent co-twin survival. The first 4 weeks after ST represent a critical vulnerability period, and risk is strongly influenced by identifiable preprocedural factors. These findings support individualized counseling, later scheduling in high-risk pregnancies, should be considered.