A fetal reduction from twin to singleton based on sonography and cell-free fetal DNA testing: A sequential approach to old pitfalls
- Resource Type
- Authors
- Shira Dvash; Yaakov Melcer; Ran Svirsky; Marina Pekar-Zlotin; Hamutal Meiri; Ron Maymon
- Source
- European Journal of Obstetrics & Gynecology and Reproductive Biology. 259:105-112
- Subject
- medicine.medical_specialty
Prenatal diagnosis
03 medical and health sciences
0302 clinical medicine
Pregnancy
Prenatal Diagnosis
medicine
Humans
030212 general & internal medicine
Twin Pregnancy
Fetus
030219 obstetrics & reproductive medicine
Singleton
business.industry
Obstetrics
Obstetrics and Gynecology
DNA
medicine.disease
Pregnancy Reduction, Multifetal
Reproductive Medicine
Cell-free fetal DNA
Cohort
Pregnancy, Twin
Gestation
Female
Trisomy
business
Cell-Free Nucleic Acids
- Language
- ISSN
- 0301-2115
Objective We examined the potential value of combining ultrasound and non-invasive prenatal screening (NIPS) of maternal blood to screen for major aneuploidies as an early approach before selective fetal reduction from twin pregnancy to singleton. Study design The sample was composed of pregnant women with di-chorionic di-amniotic twins who chose to undergo fetal reduction to singleton at 12–24 weeks of gestation. These women were asked to provide a blood sample for cell-free fetal DNA (cffDNA) testing prior to fetal reduction. Results A total of 24 pregnant women with a twin pregnancy prior to fetal reduction to singleton were enrolled. There were 8 cases with structural anomalies (33.3%) in one twin that dictated fetal reduction. The proportion of patients who underwent selective fetal reduction for fetal abnormalities was larger than in several other studies. The NIPS identified 1 case of Trisomy 13 (4.2%). The other 15 cases (62.5%) had no structural or chromosomal anomalies. The decision to undergo elective reduction of twin pregnancy to singleton was made for social reasons or upon the parents’ request. Given the 33% of structural anomalies in the cohort, a cost analysis indicated that this procedure was 6.6-fold less expensive (vs. 4.6-fold with 4% structural anomalies in other publications) than conducting invasive procedures for the entire cohort. Conclusion The findings suggest that an early anatomical scan and cffDNA can increase the overall safety margin and reduce interventional procedures before elective reduction of twin pregnancy to singleton. However, a larger cohort is needed to confirm these results.