{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T06:36:20Z","timestamp":1768026980781,"version":"3.49.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:00:00Z","timestamp":1768003200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:00:00Z","timestamp":1768003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Bonn"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate procedure-related preterm birth (PTB) following third-trimester selective termination (ST) in DC twins and to compare delivery timing with expectantly managed discordant DC twins and non-anomalous DC twins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted of all DC twin pregnancies undergoing third-trimester ST (&gt;\u200928\u00a0weeks) at a tertiary care center (2003\u20132023). Pregnancies were classified as having procedure-related complications (delivery\u2009\u2264\u20094\u00a0weeks) or uneventful (delivery\u2009&gt;\u20094\u00a0weeks). Comparator cohorts included expectantly managed discordant DC twins and non-anomalous DC twins. Outcomes included timing of delivery, cumulative incidence of PTB, and risk factor analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      90 women with DC twin pregnancies elected for ST and 85 procedures were completed. Outcome was available for 81 cases; 48 (59.3%) delivered\u2009\u2264\u20094\u00a0weeks after ST and 33 (40.7%) delivered later. Clinical chorioamnionitis was more common within the group delivered\u2009\u2264\u20094\u00a0weeks (35.4% vs. 0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Cumulative PTB incidence showed accelerated delivery between 32 and 34\u00a0weeks after ST. Independent risk factors for delivery\u2009\u2264\u20094\u00a0weeks included polyhydramnios (OR 5.68) and reduction of the presenting fetus (OR 6.51). Comparator cohorts exhibited substantially lower PTB incidence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Third-trimester ST in DC twins is associated with high PTB risk, but excellent co-twin survival. The first 4\u00a0weeks after ST represent a critical vulnerability period, and risk is strongly influenced by identifiable preprocedural factors. These findings support individualized counseling, later scheduling in high-risk pregnancies, should be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-026-08305-6","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T02:43:53Z","timestamp":1768013033000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the safety and outcomes of third-trimester selective termination in dichorionic twin pregnancies with discordant anomalies\u2014a standardized approach for counseling"],"prefix":"10.1007","volume":"313","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8302-3854","authenticated-orcid":false,"given":"Adeline","family":"Walter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Fl\u00f6ck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Jim\u00e9nez-Cruz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brigitte","family":"Strizek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Gembruch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annegret","family":"Geipel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,10]]},"reference":[{"key":"8305_CR1","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1002\/uog.15821","volume":"47","author":"A Khalil","year":"2016","unstructured":"Khalil A, Rodgers M, Baschat A et al (2016) ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 47:247\u2013263. https:\/\/doi.org\/10.1002\/uog.15821","journal-title":"Ultrasound Obstet Gynecol"},{"key":"8305_CR2","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1159\/000085078","volume":"20","author":"A Gul","year":"2005","unstructured":"Gul A, Cebeci A, Aslan H et al (2005) Perinatal outcomes of twin pregnancies discordant for major fetal anomalies. Fetal Diagn Ther 20:244\u2013248. https:\/\/doi.org\/10.1159\/000085078","journal-title":"Fetal Diagn Ther"},{"key":"8305_CR3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1002\/pd.2174","volume":"29","author":"C-M Legendre","year":"2009","unstructured":"Legendre C-M, Herv\u00e9 C, Goussot-Souchet M et al (2009) Information and decision-making process for selective termination of dichorionic pregnancies: some French obstetricians\u2019 points of view. Prenat Diagn 29:89\u201394. https:\/\/doi.org\/10.1002\/pd.2174","journal-title":"Prenat Diagn"},{"key":"8305_CR4","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1111\/j.1471-0528.2007.01639.x","volume":"115","author":"L Pasquini","year":"2008","unstructured":"Pasquini L, Pontello V, Kumar S (2008) Intracardiac injection of potassium chloride as method for feticide: experience from a single UK tertiary centre. BJOG 115:528\u2013531. https:\/\/doi.org\/10.1111\/j.1471-0528.2007.01639.x","journal-title":"BJOG"},{"key":"8305_CR5","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1016\/s0140-6736(78)92550-3","volume":"2","author":"A Aberg","year":"1978","unstructured":"Aberg A, Mitelman F, Cantz M, Gehler J (1978) Cardiac puncture of fetus with Hurler\u2019s disease avoiding abortion of unaffected co-twin. Lancet 2:990\u2013991. https:\/\/doi.org\/10.1016\/s0140-6736(78)92550-3","journal-title":"Lancet"},{"key":"8305_CR6","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1002\/uog.26126","volume":"61","author":"S Sorrenti","year":"2023","unstructured":"Sorrenti S, Di Mascio D, Khalil A et al (2023) Pregnancy and perinatal outcomes of early vs late selective termination in dichorionic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol 61:552\u2013558. https:\/\/doi.org\/10.1002\/uog.26126","journal-title":"Ultrasound Obstet Gynecol"},{"key":"8305_CR7","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1186\/s12884-020-03076-7","volume":"20","author":"G Greenberg","year":"2020","unstructured":"Greenberg G, Bardin R, Danieli-Gruber S et al (2020) Pregnancy outcome following fetal reduction from dichorionic twins to singleton gestation. BMC Pregnancy Childbirth 20:389. https:\/\/doi.org\/10.1186\/s12884-020-03076-7","journal-title":"BMC Pregnancy Childbirth"},{"key":"8305_CR8","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.1111\/aogs.14249","volume":"100","author":"M Bennasar","year":"2021","unstructured":"Bennasar M, Ponce J, Torres X et al (2021) Perinatal outcome after selective termination in dichorionic twins discordant for congenital anomalies. Acta Obstet Gynecol Scand 100:2029\u20132035. https:\/\/doi.org\/10.1111\/aogs.14249","journal-title":"Acta Obstet Gynecol Scand"},{"key":"8305_CR9","doi-asserted-by":"publisher","first-page":"100","DOI":"10.18502\/jfrh.v17i2.12873","volume":"17","author":"F Rahimi Sharbaf","year":"2023","unstructured":"Rahimi Sharbaf F, Shafaat M, Lashgari S et al (2023) Pregnancy outcome after selective fetal reduction in dichorionic twin pregnancies. J Family Reprod Health 17:100\u2013104. https:\/\/doi.org\/10.18502\/jfrh.v17i2.12873","journal-title":"J Family Reprod Health"},{"key":"8305_CR10","doi-asserted-by":"publisher","first-page":"1327191","DOI":"10.3389\/fmed.2023.1327191","volume":"10","author":"G Zou","year":"2024","unstructured":"Zou G, Ji Q, Chen J et al (2024) Perinatal outcome and timing of selective fetal reduction in dichorionic diamniotic twin pregnancies: a single-center retrospective study. Front Med 10:1327191","journal-title":"Front Med"},{"key":"8305_CR11","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ejogrb.2011.11.024","volume":"161","author":"EA Alvarado","year":"2012","unstructured":"Alvarado EA, Pacheco RPF, Alderete FG et al (2012) Selective termination in dichorionic twins discordant for congenital defect. Eur J Obstet Gynecol Reprod Biol 161:8\u201311. https:\/\/doi.org\/10.1016\/j.ejogrb.2011.11.024","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"8305_CR12","doi-asserted-by":"publisher","first-page":"335","DOI":"10.30699\/jogcr.8.4.335","volume":"8","author":"M Nurzadeh","year":"2023","unstructured":"Nurzadeh M, Moshfeghi M, Shariat M et al (2023) Optimal timing of tultifetal pregnancy reduction: the earlier the better or later. J Obstet, Gynecol Cancer Res 8:335\u2013341. https:\/\/doi.org\/10.30699\/jogcr.8.4.335","journal-title":"J Obstet, Gynecol Cancer Res"},{"key":"8305_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2024.103888","volume":"49","author":"T Weissbach","year":"2024","unstructured":"Weissbach T, Tal I, Regev N et al (2024) Late selective termination in dichorionic twins: comparing late second and third trimester procedures. Reprod Biomed Online 49:103888. https:\/\/doi.org\/10.1016\/j.rbmo.2024.103888","journal-title":"Reprod Biomed Online"},{"key":"8305_CR14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004266","volume":"20","author":"F D\u2019Antonio","year":"2023","unstructured":"D\u2019Antonio F, Eltaweel N, Prasad S et al (2023) Cervical cerclage for prevention of preterm birth and adverse perinatal outcome in twin pregnancies with short cervical length or cervical dilatation: a systematic review and meta-analysis. PLoS Med 20:e1004266. https:\/\/doi.org\/10.1371\/journal.pmed.1004266","journal-title":"PLoS Med"},{"key":"8305_CR15","doi-asserted-by":"publisher","first-page":"114","DOI":"10.4274\/jtgga.galenos.2023.2022-7-3","volume":"24","author":"B Akar","year":"2023","unstructured":"Akar B, Ceylan Y, Kahraman A et al (2023) Centile charts of cervical length in singleton and twin pregnancies between 16 and 24 weeks of gestation. J Turk Ger Gynecol Assoc 24:114\u2013119. https:\/\/doi.org\/10.4274\/jtgga.galenos.2023.2022-7-3","journal-title":"J Turk Ger Gynecol Assoc"},{"key":"8305_CR16","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1002\/uog.15668","volume":"48","author":"G Pagani","year":"2016","unstructured":"Pagani G, Stagnati V, Fichera A, Prefumo F (2016) Cervical length at mid-gestation in screening for preterm birth in twin pregnancy. Ultrasound Obstet Gynecol 48:56\u201360. https:\/\/doi.org\/10.1002\/uog.15668","journal-title":"Ultrasound Obstet Gynecol"},{"key":"8305_CR17","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.pedneo.2017.09.001","volume":"59","author":"C-C Peng","year":"2018","unstructured":"Peng C-C, Chang J-H, Lin H-Y et al (2018) Intrauterine inflammation, infection, or both (Triple I): a new concept for chorioamnionitis. Pediatr Neonatol 59:231\u2013237. https:\/\/doi.org\/10.1016\/j.pedneo.2017.09.001","journal-title":"Pediatr Neonatol"},{"key":"8305_CR18","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1097\/AOG.0000000000001246","volume":"127","author":"RD Higgins","year":"2016","unstructured":"Higgins RD, Saade G, Polin RA et al (2016) Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 127:426\u2013436. https:\/\/doi.org\/10.1097\/AOG.0000000000001246","journal-title":"Obstet Gynecol"},{"key":"8305_CR19","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1080\/14767058.2016.1214703","volume":"30","author":"O Dural","year":"2017","unstructured":"Dural O, Yasa C, Kalelioglu IH et al (2017) Comparison of perinatal outcomes of selective termination in dichorionic twin pregnancies performed at different gestational ages. J Matern Fetal Neonatal Med 30:1388\u20131392. https:\/\/doi.org\/10.1080\/14767058.2016.1214703","journal-title":"J Matern Fetal Neonatal Med"},{"key":"8305_CR20","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1002\/uog.26170","volume":"61","author":"H Miremberg","year":"2023","unstructured":"Miremberg H, Rosen H, Weisz B et al (2023) Adverse outcome following selective termination of presenting twin vs non-presenting twin. Ultrasound Obstet Gynecol 61:705\u2013709. https:\/\/doi.org\/10.1002\/uog.26170","journal-title":"Ultrasound Obstet Gynecol"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-026-08305-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-026-08305-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-026-08305-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T02:43:55Z","timestamp":1768013035000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-026-08305-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,10]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8305"],"URL":"https:\/\/doi.org\/10.1007\/s00404-026-08305-6","relation":{},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,10]]},"assertion":[{"value":"25 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All patients have given written informed approval for data collection, analysis and the use of these for research. As the Ethics Committee of the University of Bonn does not request formal approval for an anonymized retrospective analysis of clinical data, Ethical consent was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from every patient participating in this review for clinical data collection, analysis and the use of those data for research.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Consent for publication was obtained from every patient participating in this review.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"26"}}