Multifetal pregnancy reduction and selective termination TOG 2020

Question 1

Risk of cerebral palsy in singleton births, twins, triplets, quadruplets

Answer 1

1: 1/400
2: 1/100
3: 1/30
4: 1/10
>4: 1/2

Question 2

How to perform selective reduction of independent chorion?

Answer 2

KCL injection
Pregnancy loss 1/10

Question 3

When should MFPR be performed?

Answer 3

11-14 weeks

Question 4

When can selective termination be performed?

Answer 4

If fetal abnormality of DCDA twins/higher order pregnancies >16 weeks.

KCL fetacide at 32 weeks, higher risk of PTB hence wait until 32 weeks. Give steroids.

Pregnancy loss 1/5

Question 5

How to perform ST or MFPR if monochorionic?

Answer 5

Radiofrequency ablation 15-27 weeks
Bipolar diathermy cord coagulation 18-27 weeks
Infrafetal laser ablation