Selective Feticide in a Dichorionic Twin Pregnancy After IVF Following Diagnosis of Trisomy 21 in One Twin: A Case Report

In multiple pregnancies complicated by a severe fetal anomaly, selective feticide may be performed to reduce maternal risks and improve the prognosis of the unaffected twin. We present the case of a 38-year-old patient who conceived through in vitro fertilization (IVF) and was diagnosed with a dichorionic diamniotic twin pregnancy discordant for trisomy 21. Non-invasive prenatal testing (NIPT) indicated a high risk for trisomy 21 in the second twin, which was subsequently confirmed by amniocentesis and molecular genetic testing. The first twin demonstrated a normal male karyotype, whereas the second twin exhibited a male karyotype with trisomy 21. Given that selective feticide is not legally allowed in Bosnia and Herzegovina, the patient was referred to the Clinical Center of Serbia in Belgrade. Following ethical approval, selective feticide of the affected twin was performed at 33+1 weeks of gestation. The cesarean delivery at 33+6 weeks resulted in one live male neonate (2,440 g, Apgar score 6) and one stillborn male (1,900 g, Apgar score 0). The maternal postoperative course was uneventful, and the surviving infant demonstrated normal growth and neurodevelopment at one-month follow-up. This case underscores the importance of early genetic screening, multidisciplinary counseling, and awareness of legal and ethical frameworks that may necessitate cross-border management in twin pregnancies discordant for chromosomal abnormalities.