Clinical Analysis Of 167 Cases Of Twin Pregnancies With One Malformed Fetus Underwent Selective Termination During Second And Late Trimester

ObjectiveTo analyze the fetal abnormality differences of the different chorionic twin pregnancy with one malformed fetus and investigate the outcomes underwent elective termination with intracardiac injection of KCl(potassium chloride) and radiofrequency ablation, and to further prove the clinical significance of selective termination.MethodsWe analyzed 167 cases of twin pregnancies with one malformed fetus in Provincial Hospital Affiliated to Shandong University and obstetrics of Shandong Provincial Hospital Maternity Hospital from April 2002 to December 2015, of which there were 156 dichorionic twins (DC group) having been underwent selective termination with intracardiac injection of KCl and 11 monochorionic twins (MC group) having been underwent radiofrequency ablation. We analyzed the abnormality types, success rates, fetal gestational ages, birth weight of the two groups. The success of selective termination is getting a healthy child in the end.Results1.There are 43 cases of fetal brain malformations,26 cases of lymphangioma, 21cases of multiple malformations,15 cases of heart defects,9 cases of abdominal fissure,7 cases of cleft lip and palate,7 cases of skeletal deformities,6 cases of acromphalus,4 cases of malformations in Urinary System,3cases of NT (nuchal translucency) thickness,3 cases of limb deformities,3 cases of fetal hydrops,3 cases of trisomy 21,3 cases of abdominal cyst, a case of hemophilia, 1case of NF thickness and a case of trisomy 18 in the DC group. There are 4 cases of anencephalia,2 cases of multiple malformations, a case of intracranial lesion, a case of limb deformities, a case of acephalocardia, a case of exencephalia, a case of abdominal fissure in the MC group.2. The success of selective termination was technically 100%. The overall success rate is 85.06%(131/154).13 missing cases was all in the DM group, the complete lost rate is 7.78%(13/167).The success rate is 85.31%(122/143) in DC group, and the rate in MC group is 81.82%(9/11). The rates of successful operation between the two groups have no difference (P=0.67>0.05).3. There were 18 abortions and 30 premature deliveries in the DC group, and the abortion rate was 12.59% and the incidence of premature delivery was 20.98%. There were 2 abortions and 2 premature deliveries in the MC group, and the abortion rate and the incidence of premature delivery was 18.18% respectively. The mean gestational ages at delivery in DM group were 38.03±2.47 weeks and the ages in MC group were 37.94±3.08 weeks. The delivery ages of successful operation between the two groups have no difference (t=0.103, P=0.918>0.05)4.The mean birth weight was 3090±657g in DC group, and the weight in MC group was 2932±598g. The weight between the two groups have no difference (t=0.760, P=0.449>0.05)ConclusionsThe malformations of the malformed fetus between dichorionic twins and monochorionic twins are different. The outcomes at the aspects of success rates, the gestational age at delivery and neonatal birth weight between intracardiac injection of KCl and radiofrequency ablation have no significant differences.