EP10.14: Acceptance and feasibility of selective feticide in monochorionic twins in a conservative country

Medical termination of pregnancy is not authorised in Lebanon, except in very rare situations, such as maternal life threatening conditions. (Thalia Arawi and Anwar Nassar; World Bioethics 2011). In these specific cases, ethical committees convene and discuss whether to give the approval for the termination. We herein describe two cases of monochorionic diamniotic twin pregnancies that were referred to our centre for management. The first was referred in 2021 for discordance in morphology, with one fetus presenting an acrania-anencephaly sequence, and the other cases was referred in 2022 for a Twin reversed arterial perfusion (TRAP) sequence. After extensive counselling about the different options, as well as the benefits and risks of each one, the two patients expressed their wish to undergo a selective termination of pregnancy of the affected fetus. The two cases were presented before the Ethical Committee, and both demands were approved. Under local anesthesia and ultrasound guidance, umbilical cord occlusion using Storz bipolar forceps 2.4mm was successfully done at 19 and 21 weeks of gestation, respectively. The patients delivered their surviving healthy babies by Caesarean section at 36 and 33 weeks, respectively. Our report shows that, despite the complexity and the restrictions of the healthcare system in Lebanon, we were able to successfully perform two cases of umbilical cord occlusion. Such cases require a multidisciplinary approach and a proper specialised counselling. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.