Dr. Asma Khalil discusses the indications for selective reduction in multiple pregnancy. For selective reduction in DC twins, trans abdominal ultrasound-guided, intracardiac or intrafunicular injection of KCl or lignocaine with a 20-22 gauge needle is done in the first trimester. When the diagnosis is made in the second trimester, women might opt for late selective termination in the third trimester, if the law permits. For selective reduction in MC twins, the techniques include cord occlusion and Intrafetal coagulation (laser or radiofrequency ablation). Reduction in triplet pregnancy reduces extreme prematurity. For reduction in triplets, the options are to continue whole pregnancy or to terminate whole pregnancy or embryo reduction. For selective reduction in DC triplet, consider reducing the MC twins As regards the timing, selective reduction at 11-13 weeks allows for prenatal screening. Selective reduction carries higher risks if carried out at 18–19 weeks.
Dr. Khalil presents an overview of the techniques of cord occlusion and intra fetal laser. The choice of procedure depends largely on technical expertise. Newer techniques include microwave ablation and use of high intensity focussed ultrasound.
Asma Khalil (MBBCh, MD, MRCOG, MSc(Epi), DFSRH, Dip(GUM)) is a Consultant Obstetrician at St George’s Hospital and Honorary Senior Lecturer at St George’s Medical School, University of London. She is a subspecialist in Maternal and Fetal Medicine, specialising in scanning women and babies with complications in pregnancy. She is the lead for the Multiple Pregnancy service at St George’s Hospital, the referral unit for the South West London region, but also cares for women with low risk pregnancies.
Asma gained her MD at the University of London in 2009 following two years’ research into pre-eclampsia (high blood pressure in pregnancy). She also has a Masters degree in Epidemiology from the London School of Hygiene & Tropical Medicine and an MRC scholarship.