Objective

Background To evaluate the perinatal outcomes in women with complicated monochorionic diamniotic twins who underwent selective reduction using radiofrequency ablation (RFA). Methods This retrospective study included patients with complicated monochorionic diamniotic twins between 16 to 28 weeks who underwent selective reduction using RFA. Results During the study period, 143 women with complicated monochorionic twins underwent RFA including 52 with selective fetal growth restriction (sFGR), 48 with twin to twin transfusion syndrome (TTTS), 33 with major fetal anomalies in one of the twins, and 10 with reversed arterial perfusion sequence (TRAP). The overall survival was 71.3% (102/143). The procedures were technically successful in achieving selective termination in all cases. The mean ± SD of gestational age at the time of the procedure was 21.0 ± 2.3 weeks. The mean ± SD of gestational age at delivery was 34.6 ± 3.3 weeks. The mean ± SD of overall procedure-to-delivery time was 12 ± 1.7 weeks. The pregnancy success rates among sFGR, TRAP, TTTS and anomaly groups were 82.7, 80, 73 and 60.7% respectively. There were no maternal complications. Conclusion Radiofrequency ablation for fetal reduction in complicated monochorionic twin pregnancies appears to be a reasonable option. The pregnancy success rate following RFA selective reduction was highest among sFGR and TRAP groups and lowest in the anomaly group.

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onographic markers are widely used for aneuploidy screening. Shortening of the fetal long bones such as the humerus and femur is a sonographic soft marker for screening of Down syndrome in the second trimester. Ethnic differences in fetal biometric measurements have been documented. [1][2][3] Beigi and ZarrinKoub 3 reported that Iranian fetuses had a shorter femur length in comparison with western studies. Kovac et al 1 concluded that Asian groups had a less-than-expected femur length.Undoubtedly, ethnic differences in fetal femur and humerus diaphysis length would have a considerable impact on Down syndrome screening; in one study, positive sonographic results were reported more frequently in nonwhite ethnicities because of shorter long bones. 2 In our previous study, we obtained normal ranges for the fetal nasal bone during the second trimester of pregnancy. 4 The aim of this study was to provide normal ranges for femur and humerus diaphysis length during the second trimester in an Iranian population. -Reza Tahmasebpour, MD, Reihaneh Pirjani, MD, Abbas Rahimi-Foroushani, PhD, Saeed Reza Ghaffari, MD, Fatemeh Rahimi-Sharbaf, MD, Farzaneh Fattahi Masrour, MD Received November 18, 2011, from the Iranian Fetal Medicine Foundation, Tehran, Iran (A.-R.T., S.R.G., F.F.M.) Ahmad ORIGINAL RESEARCHObjectives-Shortening of the fetal long bones is a sonographic soft marker for screening of Down syndrome in the second trimester that can be influenced by ethnicity. The purpose of this study was to provide normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population.Methods-This cross-sectional study was performed on 3011 singleton fetuses at 15 to 28 weeks' menstrual age. The relationship between menstrual age and both femur and humerus diaphysis length was determined, and percentile values for each menstrual week were provided.Results-The median femur diaphysis length ranged from 18.05 mm at 15 menstrual weeks to 52.20 mm at 28 menstrual weeks, and the mean humerus diaphysis length ranged from 17.65 mm at 15 menstrual weeks to 48.10 mm at 28 menstrual weeks. There was a linear relationship between menstrual age and both femur diaphysis length (R 2 = 0.957) and humerus diaphysis length (R 2 = 0.941).Conclusions-We have provided normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population.