Radiofrequency ablation for selective fetal reduction in complicated Monochorionic twins; comparing the outcomes according to the indications

Abstract

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.

Elective fetal reduction by radiofrequency ablation in monochorionic diamniotic twins decreases adverse outcomes compared to ongoing monochorionic diamniotic twins

“…Similarly, Rahimi-Sharbaf et al 35 recently reported the outcomes of RFA for selective fetal reduction in monochorionic twins based on indication with an overall survival of the co-twin following RFA as 71.3%. Wang et al 36 also report on how indications for 272 RFA procedures may affect the perinatal outcomes of monochorionic pregnancies.…”

“…Current literature, including studies by Kumar et al, 33 Lee et al, 17 Rahimi-Sharbaf et al, 35 Ting et al, 30 and Wang et al 36 evaluate outcomes following RFA but do not specifically compare elective RFA of monochorionic diamniotic twins to ongoing twin monochorionic diamniotic twin pregnancies. In order to determine perinatal outcomes following RFA in complex monochorionic pregnancies, Kumar et al 33 prospectively studied 100 cases of selective RFA of which 72 were monochorionic diamniotic twins.…”

“…[31][32][33] In the majority of studies reporting outcomes with radiofrequency ablation (RFA) in monochorionic pregnancies, the procedure was performed for severe complications such as TRAP, TTTS, sFGR or a fetal anomaly. 17,[33][34][35] To date there is limited data reporting outcomes of RFA performed specifically in monochorionic diamniotic twins for an elective indication. The purpose of this study was to compare pregnancy outcomes in electively reduced monochorionic diamniotic twins and ongoing monochorionic diamniotic gestations at a single institution.…”

A cohort study of the perinatal outcome of radiofrequency ablation in complicated monochorionic multiple pregnancies based on a different needle insert angle

“…Previous studies have reported the treatment effect and perinatal outcomes 3 , 4 of radiofrequency ablation (RFA). However, little is known about the effect of the needle entry angle on perinatal outcomes 3 .…”

“…The RFA needle is usually percutaneously inserted through the maternal abdominal wall into the intrauterine fetal abdomen at the level of the cord insertion site of the complicated twin. 4 – 6 However, the fetus sometimes maintains a prone position or suddenly changes position after the needle enters the uterine cavity. Whether this procedure should then be interrupted or a different needle insertion angle chosen remains unclear A fetal dorsal insertion angle may increase the complexity of the operation owing to factors, including spinal obstruction, more fetal tissue to pass through, and opposite directions between the umbrella end of the ablation needle and the umbilical artery and vein.…”