Abstract
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. ACOG Practice bulletin no. 144.Obstet Gynecol. 2013; 123: 1118-1132
- European IVF-Monitoring (EIM) Consortium for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 2009: results generated from European registers by ESHRE.Hum Reprod. 2013; 28: 2318-2331
- Births: final data for 2014.Natl Vital Stat Rep. 2015; 64: 1
- Increased risk of birth defects among children from multiple births.Birth Defects Res A Clin Mol Teratol. 2003; 67: 879-885
- Comparing pregnancy outcomes and loss rates in elective twin pregnancy reduction with ongoing twin gestations in a large contemporary cohort.Am J Obstet Gynecol. 2019; 221: 253
- First-trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases.Am J Obstet Gynecol. 1993; 169: 17-21
- Chorionic villus sampling before multifetal pregnancy reduction.Am J Obstet Gynecol. 2000; 183: 1078-1081
- Outcome of first-trimester chorionic villus sampling for genetic investigation in multiple pregnancy.Ultrasound Obstet Gynecol. 2001; 17: 209-216
- Multifetal pregnancy reduction.Am J Obstet Gynecol. 2001; 185: 772-774
- Cell-free DNA analysis for noninvasive examination of trisomy.N Engl J Med. 2015; 372: 1589-1597
- Analysis of cell-free DNA in maternal blood in screening for fetal aneuploidies: updated meta-analysis.Ultrasound Obstet Gynecol. 2015; 45: 249-266
- DNA sequencing of maternal plasma to identify Down syndrome and other trisomies in multiple gestations.Prenat Diagn. 2012; 32: 730-734
- Fetal aneuploidy detection by cell-free DNA sequencing for multiple pregnancies and quality issues with vanishing twins.J Clin Med. 2014; 3: 679-692
- Performance of screening for aneuploidies by cell-free DNA analysis of maternal blood in twin pregnancies.Ultrasound Obstet Gynecol. 2015; 45: 61-66
- Noninvasive prenatal testing of trisomies 21 and 18 by massively parallel sequencing of maternal plasma DNA in twin pregnancies.Prenat Diagn. 2014; 34: 335-340
- Committee opinion No. 640: cell-free DNA screening for fetal aneuploidy.Obstet Gynecol. 2015; 126: e31-37
- ISUOG Clinical Standards Committee: ISUOG consensus statement on the impact of non-invasive prenatal testing (NIPT) on prenatal ultrasound practice.Ultrasound Obstet Gynecol. 2014; 44: 122-123
- Practice bulletin No. 163: screening for fetal aneuploidy.Obstet Gynecol. 2016; 127: 979-981
- Noninvasive prenatal detection and selective analysis of cell-free DNA obtained from maternal blood: evaluation for trisomy 21 and trisomy 18.Am J Obstet Gynecol. 2012; 206 (e1–9): 319
- First-trimester risk assessment based on ultrasound and cell-free DNA vs combined screening: a randomized controlled trial.Ultrasound Obstet Gynecol. 2018; 51: 437-444
- Nuchal translucency measurement and pregnancy outcome after assisted conception versus spontaneously conceived twins.Hum Reprod. 2001; 16: 1999-2004
- Fetal abnormalities leading to termination of pregnancy: the experience at the Assaf Harofeh Medical Center between the years 1999–2000.Harefuah. 2003; 142 (488): 405-409
- Evolution of the lambda or twin-chorionic peak sign in dichorionic twin pregnancies.Obstet Gynecol. 1997; 89: 439-441
- Incidence and significance of unequal gestational sac diameter or embryo crown-rump length in twin pregnancy.Hum Reprod. 1992; 7: 1170-1172
- First trimester embryo reduction: a medical solution to an iatrogenic problem.Hum Reprod. 1995; 10: 668-673
- Heart rate as a predictor of first-trimester spontaneous abortion after ultrasound-proven viability.Obstet Gynecol. 1991; 78: 330-334
- Optimal timing of fetal reduction from twins to singleton: earlier the better or later the better?.Ultrasound Obstet Gynecol. 2021; 57: 134-140
- The feasibility of nuchal translucency measurement in higher order multiple gestations achieved by assisted reproduction.Hum Reprod. 1999; 14: 2102-2105
- Diagnosis of fetal defects in twin pregnancies at routine 11-13-week ultrasound examination.Ultrasound Obstet Gynecol. 2020; 55: 474-481
- Screening for trisomies by cffDNA testing of maternal blood in twin pregnancy: update of the Fetal Medicine Foundation results and meta-analysis.Ultrasound Obstet Gynecol. 2019; 53: 734-742
- GENETICS COMMITTEE. Prenatal invasive procedures in women with hepatitis B, hepatitis C, and/or human immunodeficiency virus infections.J Obstet Gynaecol Can. 2014; 36: 648-653
- Pregnancy outcome following fetal reduction from dichorionic twins to singleton gestation.BMC Pregnancy Childbirth. 2020; 20: 389
- First-trimester screening for trisomy 21 in twin pregnancy: does the addition of biochemistry make an improvement?.Prenat Diagn. 2005; 25: 1156-1161
- Detection of structural abnormalities in fetuses with normal karyotype at 11-13 weeks using the anatomic examination protocol of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG).J Matern Fetal Neonatal Med. 2020; 33: 2581-2587
- Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities.Am J Obstet Gynecol. 2004; 191: 45-67
Article info
Publication history
Published online: February 17, 2021
Accepted:
February 15,
2021
Received in revised form:
February 8,
2021
Received:
November 16,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
