Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders

Nobili, Elena; Paramasivam, G.; Kumar, Sailesh

doi:10.1111/ajo.12071

Cited by 30 publications

(25 citation statements)

References 15 publications

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“…In the study of van den Bos et al [4] and Roman et al [16], RFA was associated with lower survival rates, and Bebbington et al [17] also demonstrated that the overall survival was higher in the bipolar cord occlusion group than in the RFA group, at 85.2 and 70.7%, respectively. Conversely, Nobili et al [18] showed that a higher rate was found in the RFA group than in the BCC group, at 92.3 and 90.9%, respectively. Our data also showed that the survival rates are not significantly higher in the RFA group than in the BCC group, and the survival rates of this study were lower than those declared by Nobili's results [18].…”

Section: Discussionmentioning

confidence: 98%

“…Conversely, Nobili et al [18] showed that a higher rate was found in the RFA group than in the BCC group, at 92.3 and 90.9%, respectively. Our data also showed that the survival rates are not significantly higher in the RFA group than in the BCC group, and the survival rates of this study were lower than those declared by Nobili's results [18]. In Bebbington's report [17], preterm delivery (<34 weeks), pPROM, birth weight and neonatal demise were also not significantly different between these 2 modalities.…”

Section: Discussionmentioning

confidence: 98%

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Clinical Outcomes after Selective Fetal Reduction of Complicated Monochorionic Twins with Radiofrequency Ablation and Bipolar Cord Coagulation

Ruan¹,

Xie²,

Lin³

et al. 2016

Gynecol Obstet Invest

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Aims: To review pregnancy outcomes, complication rates and neonatal neural development of selective termination procedures for complicated monochorionic (MC) twins. Methods: This was a retrospective review of the pregnancies that underwent selective reduction with radiofrequency ablation (RFA) and bipolar cord coagulation (BCC) in our institution. Results: Forty-eight cases underwent selective reduction with BCC and the remaining 45 with RFA. Overall survival was not statistically different between the RFA and BCC groups (71.1 and 62.5%, p = 0.379). With regard to the indications, the survival rates were not significantly different for twin to twin transfusion syndrome, twin reversed arterial perfusion, discordant anomalies and selective intrauterine growth restriction. Preterm premature rupture of membrane was not statistically different between the BCC and RFA groups (47.9 and 33.3%, p = 0.153). Five foetuses presented with abnormal middle cerebral artery-peak systolic velocity in the BCC group and 4 in the RFA group (p = 0.829). In the BCC group, neurological injury was detected in 2 neonates, presenting with cerebral dysplasia on MR scanning. In the RFA group, intracranial haemorrhage Grade III was detected in one neonate with cranial ultrasound (p = 0.607). Conclusions: Overall survival and complication rates following selective reduction in complicated MC twin pregnancies is similar irrespective of whether the reduction was performed using RFA or BCC. Key Message: It seems that selective reduction in MC pregnancies with RFA does not carry a significant decrease in the overall survival and complication rates than the cases with BCC. According to our data, neurodevelopmental impairment of the co-twins is relatively seldom after selective reduction.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Clinical Outcomes after Selective Fetal Reduction of Complicated Monochorionic Twins with Radiofrequency Ablation and Bipolar Cord Coagulation

Ruan¹,

Xie²,

Lin³

et al. 2016

Gynecol Obstet Invest

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“…SR via intravascular KCl injection is the primary method for selective feticide in dichorionic twins [1], but is contraindicated in monochorionic, diamniotic twin gestations due to the increased risk of co-twin injury or death [2]. There are several potential mechanisms for co-twin injury after intravascular KCl injection in monochorionic twins.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure is less invasive, as KCl injection is typically performed with a 22-gauge needle, while cord occlusion requires a probe (17-18 G) or endoscope (up to 3.8 mm in diameter) to complete [8]. These advantages may translate into lower risks and improved outcomes [2]. The fetal loss rate (miscarriage before 24 weeks) after SR of a discordant anomalous dichorionic twin via intravascular KCl injection is approximately 7.5%, although this rate varies by two percentage points depending on the gestational age the procedure is carried out [9].…”

Section: Discussionmentioning

confidence: 99%

Selective Reduction Using Intravascular Potassium Chloride Injection after Laser Surgery for Twin-Twin Transfusion Syndrome

et al. 2015

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Selective reduction (SR) via intravascular potassium chloride (KCl) injection is contraindicated in monochorionic twins due to the presence of placental vascular communications, which may serve as a conduit for inter-twin passage of KCl or allow exsanguination of the living twin into the demised twin. After successful selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS), the twins' circulatory systems are rendered independent. Theoretically, intravascular KCl injection into one twin after successful SLPCV should not result in passage of the feticidal agent nor cause hemodynamic alterations in the co-twin. We describe 3 cases of 1,069 patients (0.3%) that underwent SLPCV for TTTS between 2003 and 2013 and subsequent SR. SLPCV was successfully completed at 18⁰, 22⁶, and 23⁰ weeks' gestational age for Quintero stages III, IV, and III TTTS, respectively. SR via intravascular KCl injection was later performed at maternal request due to the risk of neurological compromise in one twin at 22⁶, 25⁴, and 23⁶ weeks' gestational age. All co-twins survived after SR, and no neurological sequelae were suspected after birth. Further study is necessary before SR can be routinely considered after laser surgery for TTTS.

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“…About one half of those pregnancies are uneventful, but the other half may be complicated by twin-totwin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), twin reversed arterial perfusion (TRAP) sequence or discordance for fetal abnormality (DFA). In the most severe forms of those complications, when one fetus is severely anomalous, or is suffering severe distress, particularly if the condition is compromising the non-affected fetus, selective fetal termination (SFT) may be the best option, as in the case of single intrauterine death of one fetus, profound consequences for the surviving twin are reported, including a 15-25% risk of death or neurological damage [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Selective fetal termination in monochorionic twin pregnancies - pregnancy outcome after bipolar cord coagulation and interstitial laser coagulation

2020

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Introduction/Objective In this paper we present the perinatal outcome after selective fetal termination (SFT) in monochorionic (MH) twins done by bipolar cord coagulation (BCC) and interstitial laser coagulation (ILC). Methods During a five-year period, SFT was done in 22 MH twins. BCC was done in 15 and ILC in seven cases. We registered the indication for SFT, gestational age at SFT, immediate postoperative death and late death of the co-twin, PPROM (preterm pre-labor rupture of membranes), gestational age at delivery/abortion, procedure-to-delivery interval, mode of delivery, neonatal body weight and 5-minute Apgar score.

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Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders

Abstract: Selective reduction in MC pregnancies carries an increased procedure-related and preterm delivery rate compared with DC pregnancies. The main indication for selective reduction was structural malformations, with a predominance of CNS anomalies.

Cited by 30 publications

References 15 publications

Clinical Outcomes after Selective Fetal Reduction of Complicated Monochorionic Twins with Radiofrequency Ablation and Bipolar Cord Coagulation

Clinical Outcomes after Selective Fetal Reduction of Complicated Monochorionic Twins with Radiofrequency Ablation and Bipolar Cord Coagulation

Selective Reduction Using Intravascular Potassium Chloride Injection after Laser Surgery for Twin-Twin Transfusion Syndrome

Selective fetal termination in monochorionic twin pregnancies - pregnancy outcome after bipolar cord coagulation and interstitial laser coagulation

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