{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T16:02:10Z","timestamp":1793203330796,"version":"4.5.0"},"reference-count":20,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: To review the outcome of complicated monochorionic pregnancies after fetoscopic selective feticide with bipolar cord coagulation in an experienced German center. Methods: All cases that underwent selective feticide using fetoscopic bipolar umbilical cord occlusion (and simultaneous dissection in monoamniotics) at the University of Bonn in the past 10 years were retrospectively analyzed for antenatal and neonatal course and outcome. An adverse outcome was defined as either intrauterine death (IUD), neonatal death (NND), preterm prelabour rupture of membranes (PPROM), or preterm delivery (PTD) before 32.0 weeks of gestation. Results: We diagnosed 56 monochorionic pregnancies, including 43 diamniotic and 8 monoamniotic twins, as well as 5 triplets, complicated by discordant fetal anomalies (n = 10), selective intrauterine growth restriction (n = 29), twin-to-twin transfusion syndrome (n = 13), twin reversed arterial perfusion sequence (n = 3), or severe early twin anemia polycythemia sequence (n = 1), that underwent fetoscopic selective feticide in the 10 years study period. Selective feticide was performed by bipolar cord coagulation at a median gestational age of 21.2 weeks. PPROM occurred in 11 cases, 7 (12.5%) before 32.0 weeks and 4 (7.1%) between 34.0 and 36.0 weeks, respectively. There were five (8.9%) co-twins IUDs at a median of 2 weeks after the intervention. We observed 12 (21.4%) PTDs before 32.0 weeks of gestation and 2 (3.6%) NNDs. Mean gestational age at delivery was 37.1 weeks, with an overall survival of the co-twin of 87.5%. Conclusion: In experienced hands, fetoscopic selective feticide is an effective treatment in complicated monochorionic pregnancies. By sacrificing a sick fetus that jeopardizes the entire pregnancy, a higher survival rate of the co-twin can be achieved.<\/jats:p>","DOI":"10.3390\/jcm11061516","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T11:46:47Z","timestamp":1646912807000},"page":"1516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience"],"prefix":"10.3390","volume":"11","author":[{"given":"Eva Christin","family":"Weber","sequence":"first","affiliation":[{"name":"Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany"},{"name":"Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3625-7097","authenticated-orcid":false,"given":"Brigitte","family":"Strizek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9135-4338","authenticated-orcid":false,"given":"Florian","family":"Recker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annegret","family":"Geipel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Gembruch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Berg","sequence":"additional","affiliation":[{"name":"Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany"},{"name":"Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Gottschalk","sequence":"additional","affiliation":[{"name":"Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000313300","article-title":"Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification","volume":"27","author":"Lewi","year":"2010","journal-title":"Fetal Diagn. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/uog.23515","article-title":"Outcome of monochorionic twin pregnancy complicated by Type-III selective intrauterine growth restriction","volume":"57","author":"Shinar","year":"2021","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1111\/1471-0528.15530","article-title":"Prognosis of the co-twin following spontaneous single intrauterine fetal death in twin pregnancies: A systematic review and meta-analysis","volume":"126","author":"Mackie","year":"2018","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1097\/AOG.0b013e31822f129d","article-title":"Co-Twin Prognosis After Single Fetal Death: A Systematic Review and Meta-Analysis","volume":"118","author":"Hillman","year":"2011","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1046\/j.1469-0705.1999.14050297.x","article-title":"Single intrauterine death in monochorionic twin pregnancies","volume":"14","author":"Nicolini","year":"1999","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S0002-9378(00)70221-3","article-title":"Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy","volume":"182","author":"Deprest","year":"2000","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1002\/uog.917","article-title":"Selective feticide in monochorionic twin pregnancies by ultrasound-guided umbilical cord occlusion: Cord occlusion in twins","volume":"22","author":"Gallot","year":"2003","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1067\/mob.2001.117190","article-title":"Complicated monochorionic twin pregnancies: Experience with bipolar cord coagulation","volume":"185","author":"Nicolini","year":"2001","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"459.e1","DOI":"10.1016\/j.ajog.2006.11.039","article-title":"Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence","volume":"196","author":"Lee","year":"2007","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1046\/j.1469-0705.1997.10020130.x","article-title":"Umbilical cord coagulation by operative microendoscopy at 16 weeks\u2019 gestation in an acardiac twin","volume":"10","author":"Hecher","year":"1997","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1002\/pd.5830","article-title":"Selective fetal reduction in complicated monochorionic twin pregnancies: A comparison of techniques","volume":"41","author":"Shinar","year":"2021","journal-title":"Prenat. Diagn."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, N., Sun, J., Wang, J., Jian, W., Lu, J., Miao, Y., Li, Y., Chen, F., Chen, D., and Ye, X. (2021). Selective termination of the fetus in multiple pregnancies using ultrasound-guided radiofrequency ablation. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04285-4"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Weber, E.C., Recker, F., Gottschalk, I., Strizek, B., Geipel, A., Gembruch, U., and Berg, C. (Ultraschall Med., 2021). Outcome of TRAP Sequence Treated in the First Trimester\u2014A Ten-Year Single-Center Experience, Ultraschall Med., online\u00a0ahead of print.","DOI":"10.1055\/a-1526-1775"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1159\/000489882","article-title":"A Modified Technique for Cord Transection in Monochorionic Monoamniotic Twin Pregnancies","volume":"44","author":"Greimel","year":"2018","journal-title":"Fetal Diagn. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1159\/000519860","article-title":"Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester","volume":"48","author":"Weber","year":"2021","journal-title":"Fetal Diagn. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/S0002-9378(99)70321-2","article-title":"Selective termination for structural, chromosomal, and mendelian anomalies: International experience","volume":"181","author":"Evans","year":"1999","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.ajog.2005.09.013","article-title":"Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies","volume":"194","author":"Lewi","year":"2006","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ajog.2008.08.039","article-title":"Umbilical cord occlusion for selective feticide in complicated monochorionic twins: A systematic review of literature","volume":"200","author":"Rossi","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1002\/uog.3816","article-title":"Twin reversed arterial perfusion: Fetoscopic laser coagulation of placental anastomoses or the umbilical cord","volume":"28","author":"Hecher","year":"2006","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1002\/uog.12408","article-title":"Perinatal outcome after selective feticide in monochorionic twin pregnancies: Perinatal outcome after selective feticide","volume":"41","author":"Bos","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1516\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:34:11Z","timestamp":1760135651000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11061516"],"URL":"https:\/\/doi.org\/10.3390\/jcm11061516","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,10]]}}}