The Role of Selective Reduction - Part 1

*SPECIAL GUEST* - Dr. Saul Snowise – Part 1 of 2

This week and next week we have a two-part series with Dr. Saul Snowise as we discuss the role of selective reduction, specifically in the setting of monochorionic twins. Join us as we discuss the following this week:

• How selective reduction differs in monochorionic vs. dichorionic twins 
  • Most common method of selective reduction
    • Potassium chloride (KCl) injection contraindicated in monochorionic twins  
  • Method for monochorionic pregnancy
    • Cord occlusion
• Indications for selective reduction in monochorionic twins
  • Selective fetal growth restriction (sIUGR)
  • Discordant anomalies
  • Twin-twin transfusion syndrome (TTTS)
  • Twin reverse arterial perfusion (TRAP) sequence
  • Failed laser
• Various methods for performing a cord occlusion selective reduction
  • Microwave
  • Interstitial laser
  • Radiofrequency ablation (RFA)
  • Bipolar cautery
• Sizes of operative instruments, energy levels used and the treatment protocols
• Gestational age thresholds for performing a selective reduction procedure
• Risks associated with a selective reduction procedure
  • Membrane complications (i.e. PPROM)
  • Preterm delivery
  • Bleeding, infection 
  • Loss of co-twin
• Pre-operative counseling with patients
• Follow-up and surveillance for the remainder of the pregnancy

Tune in next week for part 2!