Selective fetocide reverses preeclampsia in discordant twins.

Abstract

Preeclampsia occurs in some twin gestations in association with a placental disorder of one but not both fetuses, thereby placing both at risk. We investigated a novel method of treating preeclampsia in these pregnancies. Three patients with second trimester preeclampsia linked to a lethal condition in one twin were treated with selective fetocide in an effort to reverse preeclampsia. Two patients presented with twins discordant for severe fetal growth restriction, and 1 patient presented with Ballantyne syndrome and twins discordant for fetal hydrops. Preeclampsia resolved in all 3 patients, allowing continuation of the pregnancy for an additional 9 to 23 weeks before delivery of the remaining fetus. Resolution of preeclampsia occurred in a timeframe consistent with placental involution documented in similar clinical circumstances. Selective fetocide may be an option for treating preeclampsia in some twin pregnancies, presumably by causing involution of the pathologic placenta. Delivery is not the only cure for preeclampsia.