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The Northwestern University Twin Study XV: Rationales for a Standard of Care in Compromised Twin Pregnancies

Published online by Cambridge University Press:  01 August 2014

J.P. Minogue ,
R.K. Tamura  and
L.G. Keith
J.P. Minogue*
Affiliation:
Department of Obstetrics and Gynecology, Prentice Women's Hospital and Maternity Center, Northwestern University Medical School, Chicago, Illinois, USA
R.K. Tamura
Affiliation:
Department of Obstetrics and Gynecology, Prentice Women's Hospital and Maternity Center, Northwestern University Medical School, Chicago, Illinois, USA
L.G. Keith
Affiliation:
Department of Obstetrics and Gynecology, Prentice Women's Hospital and Maternity Center, Northwestern University Medical School, Chicago, Illinois, USA
*
Department of Obstetrics and Gynecology, Northwestern University Medical School, 333 East Superior Street, Suite 461, Chicago IL 60611, USA

Abstract

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Current antenatal technologies have improved the obstetrician's ability to assess fetal well-being as well as to diagnose fetal compromise. These technologies have given rise to very difficult ethical issues in the management of compromised twin pregnancies: for example, a choice must be made between putting a healthy twin at risk due to preterm delivery for the sake of a compromised cotwin or of allowing the compromised twin to die in order to buy time for the healthy twin. Though each case is unique, good medical practice requires a standard of care by which consistent patient management can be proposed. In the pluralistic environment of Northwestern Memorial Hospital, our staff has favored a standard of care based on patient autonomy. This approach demands: 1) a practitioner who offers a thorough explanation of the diagnosis and possible treatment approaches; 2) time for the patient and her partner to assimilate this information and test treatment options against their personal value system; 3) a third, but disinterested, party to facilitate patient understanding and value clarification; 4) a practitioner either willing to support the patient's decisions or refer her to another practitioner who will.

Keywords

BioethicsCompromised fetusesTwin pregnancy
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 39 , Issue 3 , July 1990 , pp. 379 - 382
Copyright
Copyright © The International Society for Twin Studies 1990

References

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