AUTHOR=Zou Gang , Ji Qingfang , Chen Jianping , Zhang Luye , Sun Qianqian , Shi Yaqi , Yang Yingjun , Zhou Fenhe , Wei Xing , Sun Luming TITLE=Perinatal outcome and timing of selective fetal reduction in dichorionic diamniotic twin pregnancies: a single-center retrospective study JOURNAL=Frontiers in Medicine VOLUME=Volume 10 - 2023 YEAR=2024 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1327191 DOI=10.3389/fmed.2023.1327191 ISSN=2296-858X ABSTRACT=Objective:The aim of this study was to evaluate the pregnancy outcomes of dichorionic diamniotic twin pregnancies that were reduced to singletons at different gestational age.Study Design : This was a retrospective cohort study of twin pregnancies that underwent fetal reduction to singletons in a single tertiary referral center between 2011 and 2020. A total of 433 cases was included. The cohort was divided into 5 groups according to gestational age at surgery: group A: <16 weeks (125 cases); group B: 16-19 +6 weeks (80 cases); group C: 20-23 +6 weeks (74 cases); group D: 24-26 +6 weeks (48 cases); group E: ≥27 weeks (106 cases). Outcome data was obtained by reviewing the electronic medical records or interviews.Results: Selective reduction was technically successful. Clinical characteristics of population were not different. The overall livebirth rate and survival rate were 96.5% and 95.4%, respectively. Although the rate of spontaneous miscarriage was comparable, gestational age at delivery differed significantly among groups (P<0.001), and there was a trend that gestational age at delivery decreased with the increasing gestational age at surgery in Group A, B, C and D, whereas gestational age at delivery in This is a provisional file, not the final typeset article Group E was later than that in Group D. In Group A, B, C and D, the rates of preterm birth <32 weeks and <34 weeks increased with the increasing gestational age at surgery, while the rates in Group E were significantly lower than that in Group D. Regression analysis showed that timing of reduction may be an independent factor after adjusting for maternal age, parity, pre-pregnancy BMI, ART and cervical length.Conclusions:Selective reduction in experienced hands for a dizygotic abnormal twin is safe and effective. Gestational age at surgery (<26 +6 weeks) was inversely correlated with gestational age at delivery and positively with the rate of preterm birth. Reduction after 27 weeks, where legal, can be performed with a good outcome for the retain fetus.