Radiofrequency ablation <i>vs</i> bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies

Bebbington, Michael; Danzer, Enrico; Moldenhauer, Julie S.; Khalek, Nahla; Johnson, Mark P.

doi:10.1002/uog.11122

Cited by 105 publications

(131 citation statements)

References 12 publications

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“…4 Reported methods for selective feticide include fetoscopic laser coagulation, bipolar cord coagulation, radiofrequency ablation, cord occlusion by ligation or photocoagulation and interstitial laser coagulation. [5][6][7][8][9][10] Perinatal survival rates following selective feticide vary between 65 and 92%, depending on indication and technique. 6 Reliable data on the long-term neurodevelopmental outcome in surviving twins is scarce.…”

Section: Introductionmentioning

confidence: 99%

Long‐term neurodevelopmental outcome after selective feticide in monochorionic pregnancies

Klink

Koopman

Middeldorp

et al. 2015

BJOG

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ObjectiveTo assess the incidence of and risk factors for adverse long‐term neurodevelopmental outcome in complicated monochorionic pregnancies treated with selective feticide at our centre between 2000 and 2011.DesignObservational cohort study.SettingNational referral centre for fetal therapy (Leiden University Medical Centre, the Netherlands).PopulationNeurodevelopmental outcome was assessed in 74 long‐term survivors.MethodsChildren, at least 2 years of age, underwent an assessment of neurologic, motor and cognitive development using standardised psychometric tests and the parents completed a behavioural questionnaire.Main outcome measuresA composite outcome termed neurodevelopmental impairment including cerebral palsy (GMFCS II‐V), cognitive and/or motor test score of <70, bilateral blindness or bilateral deafness requiring amplification.ResultsA total of 131 monochorionic pregnancies were treated with selective feticide at the Leiden University Medical Centre. Overall survival rate was 88/131 (67%). Long‐term outcome was assessed in 74/88 (84%). Neurodevelopmental impairment was detected in 5/74 [6.8%, 95% confidence interval (CI), 1.1–12.5] of survivors. Overall adverse outcome, including perinatal mortality or neurodevelopmental impairment was 48/131 (36.6%). In multivariate analysis, parental educational level was associated with cognitive test scores (regression coefficient B 3.9, 95% CI 1.8–6.0). Behavioural problems were reported in 10/69 (14.5%).ConclusionsAdverse long‐term outcome in survivor twins of complicated monochorionic pregnancies treated with selective feticide appears to be more prevalent than in the general population. Cognitive test scores were associated with parental educational level.Tweetable abstractNeurodevelopmental impairment after selective feticide was detected in 5/74 (6.8%, 95% CI 1.1–12.5) of survivors.

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Section: Introductionmentioning

confidence: 99%

Long‐term neurodevelopmental outcome after selective feticide in monochorionic pregnancies

Klink

Koopman

Middeldorp

et al. 2015

BJOG

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“…Bebbington et al reported no neonatal or maternal adverse events with the use of RFA in 58 pregnancies 2 . In-utero limb ischemia has been a reported complication of TTTS 3 .…”

Section: Limb Arteriovenous Malformation Identified After Radiofrequementioning

confidence: 98%

Limb arteriovenous malformation identified after radiofrequency ablation for selective termination in twin-to-twin transfusion syndrome

Rebarber

Dolin

Fox

et al. 2013

Ultrasound Obstet Gynecol

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“…Bipolar diathermy cord occlusion has been superseded by minimally invasive techniques, as the risks of pPROM and PTL were elevated (27%, 22%, respectively, survival 85%) [76]. Fetoscopic laser reports a 80% survival with pPROM in 18% and PTL in 3% within 28 days of procedure [79]; RFA reports a 70 -92% survival rate [76,80] with a pPROM and preterm labour rate of 14% and 7%, respectively [76]. Hence, minimally invasive techniques reduce but do not remove the risks, without changing survival rates.…”

Section: Twin-reversed Arterial Perfusion Sequencementioning

confidence: 99%

Pathophysiological mechanisms of high-intensity focused ultrasound-mediated vascular occlusion and relevance to non-invasive fetal surgery

Shaw

Haar

Rivens

et al. 2014

J. R. Soc. Interface.

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ReviewCite this article: Shaw CJ, ter Haar GR, Rivens IH, Giussani DA, Lees CC. 2014 Pathophysiological mechanisms of high-intensity focused ultrasound-mediated vascular occlusion and relevance to non-invasive fetal surgery. J. R. Soc. High-intensity focused ultrasound (HIFU) is a non-invasive technology, which can be used occlude blood vessels in the body. Both the theory underlying and practical process of blood vessel occlusion are still under development and relatively sparse in vivo experimental and therapeutic data exist. HIFU would however provide an alternative to surgery, particularly in circumstances where serious complications inherent to surgery outweigh the potential benefits. Accordingly, the HIFU technique would be of particular utility for fetal and placental interventions, where open or endoscopic surgery is fraught with difficulty and likelihood of complications including premature delivery. This assumes that HIFU could be shown to safely and effectively occlude blood vessels in utero. To understand these mechanisms more fully, we present a review of relevant cross-specialty literature on the topic of vascular HIFU and suggest an integrative mechanism taking into account clinical, physical and engineering considerations through which HIFU may produce vascular occlusion. This model may aid in the design of HIFU protocols to further develop this area, and might be adapted to provide a non-invasive therapy for conditions in fetal medicine where vascular occlusion is beneficial.

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Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies

Abstract: Objective

Cited by 105 publications

References 12 publications

Long‐term neurodevelopmental outcome after selective feticide in monochorionic pregnancies

Long‐term neurodevelopmental outcome after selective feticide in monochorionic pregnancies

Limb arteriovenous malformation identified after radiofrequency ablation for selective termination in twin-to-twin transfusion syndrome

Pathophysiological mechanisms of high-intensity focused ultrasound-mediated vascular occlusion and relevance to non-invasive fetal surgery

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