Multicentre Evaluation of Perinatal Outcomes After Selective Feticide in Dichorionic Twins in Italy

Objective: We aimed to evaluate the current clinical practice regarding selective termination of pregnancy in dichorionic (DC) twin pregnancies in Italy to establish a national protocol. Methods: This was a retrospective, multicentre analysis of selective termination in DC twin pregnancies from 2010 to 2021 performed under ultrasonographic guidance using a transabdominal injection of potassium chloride via an 18- or 20-gauge needle at a gestational age (GA) before fetal viability. Maternal and fetal characteristics and perinatal outcomes were collected accordingly. The primary outcome was preterm delivery before 32 weeks of gestation. Results: A total of 253 patients underwent selective termination at a mean GA of 17.6 weeks. Follow-up information was available for 199 patients. The rates of fetal (6%) and neonatal (0.5%) deaths were low. The mean GA at delivery was 36.5 weeks (24–42) with 23/199 (11.5%) preterm deliveries before 32 weeks. The only variable associated with primary outcome was GA at procedure, > 18 weeks (odds ratio, 2.95 [95% confidence interval 1.07–8.09]). Conclusion: This is the first Italian multicentre evaluation of selective termination of pregnancy in DC pregnancies. Our data suggest that the risk of preterm delivery can be reduced if the procedure is performed before 18 weeks of GA.