• Hua Liao, Zhaomin Zeng, Hongyan Liu, Qing Hu, and Haiyan Yu.
• Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
• Medicine (Baltimore). 2022 Nov 25; 101 (47): e31484e31484.

RationalePreeclampsia is a major cause of maternal and perinatal morbidity and mortality. Growth discordance is associated with an increased risk of preeclampsia in twin pregnancies. The management of preeclampsia combined with discordant twins is difficult and controversial because of severe maternal conditions and severe growth restriction in 1 twin.Patient ConcernsA 34-year-old woman with dichorionic diamniotic twin pregnancy complicated by preeclampsia at 29 weeks of gestation, and 1 twin with severe growth restriction and fetal intracranial hemorrhage.DiagnosisThe patient developed severe preeclampsia with high blood pressure (>160/100 mm Hg) and proteinuria, hydrothorax and leg edema. Ultrasound examination confirmed growth restriction (weight estimation: 915 g, <1st percentile) and abnormal umbilical flow in 1 twin (twin B), with a normal co-twin (estimated weight: 1693 g) (twin A). Magnetic resonance imaging revealed intracranial hemorrhage in the germinal matrix of twin B.InterventionsSelective termination of twin B by intracardiac injection of potassium chloride was performed at 31 weeks and 2 days' gestation.OutcomesSymptoms of preeclampsia resolved after selective termination, allowing the pregnancy to be prolonged for nearly 4 weeks. A healthy female infant was delivered at 35 weeks of gestation.ConclusionDelivery of both fetus is not the only choice for the management for twin pregnancy with severe preeclampsia and discordant twins. Selective termination of the fetus with poor prognosis could be a reasonable treatment choice in carefully selected cases.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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