Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy.

Abstract

In monochorionic twin pregnancy in which one twin is a nonviable fetus, selective feticide may be considered. We aimed to occlude the umbilical cord with a bipolar forceps for doing so. This was a multicenter experience in 10 consecutive patients either with twin-to-twin transfusion syndrome and one fetus affected by a condition not compatible with normal extrauterine life or with acardiac twinning. There were no intraoperative problems, and the mean procedure time was 17.5 minutes. The flow was stopped in all 10 cases. Two cases were complicated by rupture of the fetal membranes within 2 days, and the pregnancies were terminated. The other 8 pregnancies resulted in the live birth of a healthy baby. The mean interval between procedure and birth was 15.1 weeks (range, 7-20 weeks). In one patient emergency cesarean delivery for abruptio placentae was done at 26 weeks, 7 weeks after the procedure. The other 7 patients were delivered beyond the 36th week of gestation. All 8 children are alive and well, with a mean follow-up of at least 1 year. Bipolar coagulation is a safe, effective, and simple procedure for cord coagulation that is feasible through a single port and can be performed solely under ultrasonographic guidance.