Selective Reduction (Monochorionic)

Because of the shared blood supply, we cannot simply use medication. Instead, we must use techniques that physically block the blood flow in the target twin's umbilical cord:

• Bipolar Cord Coagulation (BCC): Using a specialized 3mm forceps, we use electrical energy to 'pinch' and seal the umbilical cord.
• Radiofrequency Ablation (RFA): Using a fine needle to cauterize the cord base (often used for earlier gestations or specific twin positions).
• Laser Cord Coagulation: Using high-powered laser light to seal the vessels.

This procedure is indicated when one twin in a shared placenta pregnancy has:

• A Severe Structural Anomaly: Such as anencephaly or a major heart defect that cannot be treated.
• Stage III sFGR: Where the small twin's blood flow is so unpredictable that it poses a 30-40% risk of sudden stroke or death for the healthy twin.
• Severe TTTS: In specific cases where laser ablation of individual vessels is not possible.

The evaluation is technically rigorous:

1. Doppler Mapping: Identifying the 'point of no return' in the umbilical cord where the closure must occur.
2. Brain Assessment: Using specialized ultrasound to confirm the healthy twin has not yet been affected by their sibling's condition.
3. Counseling: Providing families with a dedicated multidisciplinary team to discuss the medical necessity of protecting the healthy twin's survival and brain function.

The procedure is done in our fetal surgery suite:

• Precision Entry: Under ultrasound guidance, the chosen instrument (BCC forceps or RFA needle) is guided into the uterus.
• The Seal: The umbilical cord of the affected twin is grasped or ablated until all blood flow has permanently stopped.
• Confirmation: We verify that the healthy twin's heart remains strong and their blood pressure is stable throughout the procedure.
• Recovery: A 24-hour hospital stay for observation is typical to monitor for any signs of premature labor.

The primary goal is the protection of the healthy twin.

• Survival: At our Unit, the survival rate for the healthy twin after selective reduction is approximately 90-95%.
• Neuro-protection: By surgically closing the placenta connections, we virtually eliminate the risk of the healthy twin suffering a stroke due to shared placental plumbing issues.
• Birth: Most survivors go on to be born at term or near-term as healthy singleton babies.

Complications in monochorionic twins can escalate suddenly. If you are told that 'one twin is not growing' or 'one twin has a major defect,' you must see a fetal therapy expert immediately.

Our team, led by Dr. Werner Diehl and Dr. Ali Al-Ibrahim, performs these highly specialized surgeries regularly. We understand the technical 'shared destiny' of monochorionic twins and provide the expert intervention needed to safeguard the health of your healthy baby.