Radiofrequency Ablation in Complicated Monochorionic Pregnancy: Initial Experience

Abstract

To evaluate outcomes of complicated monochorionic pregnancies intervened by radiofrequency ablation (RFA) and report the initial experience. It is a retrospective case series of 15 cases of complicated monochorionic twin pregnancies intervened by RFA in Mediscan Systems Chennai, a tertiary referral Fetal Medicine center, from February 2015 till February 2017. Perinatal outcomes were available for all 15 cases. Main indication for RFA was sIUGR in 10 cases, of which 2 had coexistent Twin to Twin Transfusion syndrome. The procedure was technically successful in all cases. Median gestational age at procedure was 22.6 weeks (IQR 21, 25.6). The median number of RFA cycles to attain cardiac asystole was 4 (IQR 3, 7). Four of the fifteen cases (27%) had procedure related complications of which 3 occured within 2 weeks of procedure. There were 2 cases of preterm premature rupture of membranes which occurred within 2 weeks of procedure. One case had a miscarriage within 2 weeks of procedure at 21 weeks, another one had a mid-trimester loss 4 weeks after the procedure at 26 weeks. The median gestational age at delivery was 35 weeks (IQR 29.3, 35.5). Seventy-eight percent of the live borns were delivered after 34 weeks. The median procedure delivery interval was 10.4 weeks (IQR 4.1, 13.6). Median birth weight at delivery was 2000 g (IQR 1300, 2600). The present series had a live birth rate of 87%. In this initial small series, there was a good outcome in terms of live birth rates and take home baby rates. The efficacy needs to be ascertained by larger series and long term neurological outcome.

Selective fetal reduction in monochorionic twins: Preliminary experience

“…Van Den Bos et al (6) reported an overall PPROM rate of 19.8% with 43.5% babies born between 28 and 37 weeks’ gestation. Bebbington et al (8) reported an overall PPROM rate of 21.9% after RFA and BCC with preterm delivery (<34 weeks) in 59% of RFA and 44% of BCC procedures (11). In our series, 30% women delivered before 32 weeks.…”

“…This is probably one of the few studies from developing countries to deal with selective fetal reduction in complicated monochorionic twin pregnancies. The only other studies from our country include a retrospective series of 15 cases of complicated monochorionic twin pregnancies managed by RFA (11) and a single case of complicated TRAP sequence managed by interstitial laser (12).…”

Selective fetal reduction in monochorionic twins: Preliminary experience

“…This is probably one of the few studies from developing countries to deal with selective fetal reduction in complicated monochorionic twin pregnancies. The only other studies from our country include a retrospective series of 15 cases of complicated monochorionic twin pregnancies managed by RFA [11] and a single case of complicated TRAP sequence managed by interstitial laser [12]. Even though we performed the procedure in a small number of patients, this study highlights the feasibility of selective fetal reduction in complicated monochorionic twins in a low-resource setting.…”