Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Lu, Jianhua; Ting, Yuen Ha; Law, Kenneth S.; Lau, Tze Kin; Leung, Tak Yeung

doi:10.1159/000355406

Cited by 33 publications

(41 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We and others have likewise published large series over the past decades that have delineated the similarities and differences when there is a confirmed abnormality [52,53]. Much of this literature focuses on twins - many of which have twin-to-twin transfusion syndrome in which laser therapy has become the mainstay of therapy, but selective termination is still sometimes necessary [54]. A complete discussion of these issues is beyond the scope of this paper.…”

Section: Changing Perspectivesmentioning

confidence: 99%

Fetal Reduction: 25 Years' Experience

2014

View full text Add to dashboard Cite

Fetal reduction (FR) began in the 1980s to salvage the pregnancies of couples needing fertility therapy who were finally successful but with too many fetuses. Since then, it has gone from a rarity performed in only the highest risk situations to an integral fail-safe of infertility practice. Our understanding of the problems of multiple and premature births has increased - even twins carry 4-5 times more risk than singletons. Evaluation of fetuses before FR has permitted more intelligent choices and improved resultant outcomes. We now perform chorionic villus sampling in approximately 85% of cases, obtain fluorescent in situ hybridization (FISH) results overnight, and then perform FR the next day. Decisions about which to reduce prioritize anomalies, but now can include fetal gender in the decision process, as couples are now just as likely to want girls as boys. In Mendelian cases, sophisticated molecular analyses permit diagnoses before FR, and new uses such as paternity analysis can be performed. Ethical arguments have also evolved; as with many technologies in which the start was for only ‘life or death cases', FR has also moved into ‘quality of life' issues. FR of twins to a singleton now compromise about 30% of our cases.

show abstract

Section: Changing Perspectivesmentioning

confidence: 99%

Fetal Reduction: 25 Years' Experience

2014

View full text Add to dashboard Cite

show abstract

“…An overview of survival rates of TRAP sequence treated with RFA is presented in table 3[8,16,17,18,19,20,21,22,23]. We excluded the reports that included the cases also reported in other references.…”

Section: Discussionmentioning

confidence: 99%

“…The natural history for TRAP sequence progresses to >50% mortality of the pump twin because of high-output heart failure or premature delivery caused by polyhydramnios [1]. Various intrauterine interventions focused on disruption of perfusion into the acardiac twin have been introduced to improve the outcome of the pump twin: cord coagulation [2,3], umbilical cord ligation [4], photocoagulation of the anastomoses [5], interstitial laser therapy [6,7,8] and radiofrequency ablation (RFA) [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. …”

Section: Introductionmentioning

confidence: 99%

“…Conversely, an internally cooled electrode can maintain a low electrode temperature, avoid the increase in tissue impedance even with high power and achieve an increase in necrosis volume [26]. At present, in most of the reports regarding RFA for TRAP sequence, an expandable needle electrode was used [8,9,10,11,12,13,14,15,16,17,18,19,20,21] but only a few case reports describe an internally cooled electrode [22,23]. Therefore, it remains unknown which electrode is more suitable for the treatment of TRAP sequence.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Wagata

Murakoshi²,

Ishii³

et al. 2016

Fetal Diagn Ther

View full text Add to dashboard Cite

Objective: The study aims to evaluate the efficacy of radiofrequency ablation (RFA) with an internally cooled electrode for twin reversed arterial perfusion (TRAP) sequence. Methods: From April 2008 through December 2014, we retrospectively reviewed all patients who underwent RFA with an internally cooled electrode for TRAP sequence at 3 tertiary referral centers in Japan. Results: Twenty-five monochorionic diamniotic twin pregnancies underwent RFA with an internally cooled electrode for TRAP sequence at 16-27 weeks of gestation. In all cases, umbilical cord blood flow cessation in the acardiac twin was confirmed by ultrasonography with color Doppler. There were 2 cases of procedure-related complications: 1 case of unintentional septostomy and 1 case of anemia in a pump twin. Fetal demise of the pump twin occurred in 3 (12%) cases. Twenty-two (88%) of 25 pump twins were delivered alive. The median gestational age at delivery was 36 + ³ weeks (range 25 + ²-40 + ⁵ weeks). There were 14 cases (64%) of premature deliveries before 37 weeks and 5 (23%) before 32 weeks. Conclusion: RFA with an internally cooled electrode is a feasible and effective procedure for the treatment of TRAP sequence.

show abstract

“…Puede demostrarse que, en el conocimiento actual de la medicina, "aborto terapéutico" es correcto, pues no queda otra alternativa que matar al feto (remoción de la causa de patología y por ende terapéutica) para salvar a la madre. La demostración proviene del caso de embarazo múltiple, en el que uno o más fetos, pero no todos, están causando el deterioro y muerte materna; en estos casos se ha matado selectivamente a ese o más fetos con lo que se ha conseguido salvar a la madre y a los otros fetos, llegando finalmente a un parto múltiple con uno o más fetos muertos y retenidos (24)(25)(26). Nótese que aquí no se produce la interrupción del embarazo ni tampoco el aborto entendido como expulsión ex útero de ese feto.…”

Section: Caso En Que No Se Aplica La Ddeunclassified

Aproximación ética científica al doble efecto o único bien posible en el aborto terapéutico

Valenzuela

2016

Acta bioeth.

View full text Add to dashboard Cite

Resumen: El estudio muestra como la doctrina o principio del doble efecto (DDE) de una acción con efecto secundario negativo no puede aplicarse a todos los casos de aborto terapéutico (AT). Con el análisis de las causas e indicación de AT se demuestra que solo algunos de estos corresponden a DDE. Cuando no es el feto el que lleva a la madre a tener un embarazo de alto riesgo con amenaza de daño severo o muerte para ella, el caso puede adscribirse a la DDE; cuando es el feto directa o indirectamente el que causa a lleva a ese riesgo materno, el caso no se adscribe a la DDE. Si el feto es la causa de la muerte inminente de la madre, la remoción de la causa, que es la terapia adecuada, coincide con matarlo; entonces la acción buena (salvar a la madre tratándola causalmente) es la misma que la mala (matar al feto), situación que no puede asimilarse sea a la DDE o a la doctrina del mal menor. Más aún, decidir no interrumpir el embarazo produciría la muerte de la madre y el feto. El caso debería adscribirse al principio del único bien posible.Palabras clave: aborto terapéutico, doble efecto, ética, ética científica, único bien posible Scientific ethical approach to double effect or only possible good in therapeutic abortionAbstract: This study shows the inapplicability of the doctrine of double effect (DDE) to all the cases of therapeutic abortion (TA). The causes of the maternal risk define cases that cannot be included in the DDE. When it is not the embryo or fetus that produces the mother pathology the case can be assigned to the DDE. When the embryo or fetus produces directly or indirectly the process that threatens the mother's life the case cannot be assigned to the DDE. If the fetus is the cause of the imminent mother's death, the removal of the cause, that is the proper therapy, coincides with killing him or her; then the good action (to save therapeutically the mother) is the same to the bad action (to kill the fetus) and this situation cannot be assimilated either to the DDE or to the doctrine of the lesser evil. Deciding not to kill the fetus will produce the death of the mother and the fetus. So this situation should be ascribed to the principle of the unique possible well. Key words: therapeutic abortion, double effect, ethics, scientific ethics, unique possible goodAproximação ética científica ao duplo efeito ou único bem possível no aborto terapêutico Resumo: O estudo mostra como a doutrina ou princípio do duplo efeito (DDE) de uma ação com efeito secundário negativo não pode aplicar-se a todos os casos de aborto terapêutico (AT). Com a análise das causas e indicação de AT se demonstra que só alguns destes correspondem a DDE. Quando não é o feto que leva a mãe a ter uma gravidez de alto risco com ameaça de dano severo ou morte para ela, o caso pode circunscrever-se à DDE; quando é o feto direta ou indiretamente quem causa ou leva a esse risco materno, o caso não se circunscreve a DDE. Se o feto é a causa da morte iminente da mãe, a remoção da causa, que é a terapia adequada, coincide em matá-lo; então a...

show abstract

Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Cited by 33 publications

References 22 publications

Fetal Reduction: 25 Years' Experience

Fetal Reduction: 25 Years' Experience

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Aproximación ética científica al doble efecto o único bien posible en el aborto terapéutico

Contact Info

Product

Resources

About