Selective fetal reduction in monochorionic twins: Preliminary experience

Dadhwal, Vatsla; Sharma, Aparna; Deka, Dipika; Chawla, Latika; Agarwal, Nutan

doi:10.4274/jtgga.galenos.2018.2018.0052

Cited by 14 publications

(9 citation statements)

References 11 publications

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“…This rate is similar to other studies. In studies by Dadhwal et al, 8 Bebbington et al, 17 Lu et al 18 and Kumar et al, 5 the success rate was near 100%, whereas in a study by Rossi and D' Addario, failure of feticide occurred in 9% of RFA cases. 12 Paramasivam et al reported 35 cases using RFA: the technical successful rate was 100%; however, there were only three cases of TTTS Stage IV.…”

Section: Discussionmentioning

confidence: 95%

“…7 In cases with the demise of one fetus, the remaining fetus encounters some complications due to blood transfusions through placental anastomosis which results in brain hypoperfusion, brain damage (20% to 30%) and the death of the co-twin (10%). 8 Selective reduction of the fetus is one of the therapeutic methods in complicated monochorionic twins. 9 Typically, in the absence of intervention, both fetuses may die.…”

Section: Introductionmentioning

confidence: 99%

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Success Rate and Perinatal Outcomes of Selective Reduction by Radiofrequency Ablation in Monochorionic Multiple Pregnancies with a Hydropic Fetus; A Prospective Interventional Single-Arm Study

et al. 2022

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Background: Selective reduction of the fetus is one of the therapeutic methods in complicated monochorionic twins. The present study aimed to investigate the success rate and perinatal outcomes of selective reduction using radiofrequency ablation (RFA) in monochorionic multiple pregnancies with a hydropic fetus. Methods: This prospective interventional single-arm study was conducted in a referral hospital from 2017 to 2019. Totally, 27 complicated monochorionic twin and triplet pregnancies underwent RFA to occlude the umbilical vein of the hydropic fetus. The participants were followed until 2 months post-delivery. Procedure success rate, survival rate, gestational age at delivery, and neonatal outcome were evaluated. Results: The umbilical cord in 26 (96.2%) cases was successfully occluded by RFA with no maternal complications. Live birth was within 75%. The mean±SD age at delivery was 34.4±3.83 weeks. The gestational age at delivery in TTTS (twin-to-twin transfusion syndrome)-induced hydrops was significantly lower than the non-TTTS hydrops group (P=0.003). Four cases experienced preterm premature rupture of the membranes (PPROM) before 34 weeks. Of all viable neonates, 8 cases were admitted to the neonatal intensive care unit (NICU). In 2 months follow-up post-delivery, all neonates had normal findings without any adverse outcomes. Conclusion: Selective reduction by RFA in complicated monochorionic pregnancies with a hydropic fetus may be a safe method with a high success rate and 100% neonatal survival. This method may be optimal for feticide in non-TTTS hydropic twins.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Success Rate and Perinatal Outcomes of Selective Reduction by Radiofrequency Ablation in Monochorionic Multiple Pregnancies with a Hydropic Fetus; A Prospective Interventional Single-Arm Study

et al. 2022

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“…Notably, Ting et al 21 and Sun et al 17 also found that more than four RFA ablation cycles (adjusted odds ratio (OR), 5.21 (95% CI, 1.13-24.11)) and more than two RFA ablation cycles (adjusted OR, 3.46 (95% CI, 1.34-8.94)) were associated with a higher risk of fetal loss. A greater number of ablation cycles may be required when the procedure is hindered by conditions such as larger umbilical vessels 14,17 and suboptimal fetal or placental position 22,23 , which make it more difficult to interrupt the umbilical cord blood flow, thereby increasing the risk of thermal injury and hemodynamic deterioration 17 . However, it should be noted that there was no relationship between ablation duration and perinatal outcome in our study (Table S6) because the duration of one ablation cycle differed between individuals (Sun et al 17 reported similar findings).…”

Section: Discussionmentioning

confidence: 99%

Perinatal and neurodevelopmental outcome in complicated monochorionic pregnancy after selective fetal reduction: radiofrequency ablation vs microwave ablation

Gong

Wang

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives To summarize our experience in the application of radiofrequency ablation (RFA) and microwave ablation (MWA) for selective fetal reduction in complicated monochorionic pregnancies and compare the perinatal outcome of the two techniques. Methods This was a retrospective study of data from a consecutive cohort of all monochorionic twin pregnancies that underwent selective fetal reduction with RFA or MWA at Peking University Third Hospital, Beijing, China from January 2012 to December 2018. All surviving cotwins were followed up to assess their neurodevelopment using the Age & Stage Questionnaire, Chinese version. Perinatal and neurodevelopmental outcomes were compared between the RFA and MWA groups. We also fitted multivariable models to test the association between procedure‐related factors and the main perinatal outcomes, including preterm birth (PTB) < 37 weeks' gestation, intrauterine fetal death (IUFD) of the cotwin, adverse outcome (defined as occurrence of IUFD of the cotwin, termination of pregnancy or PTB < 28 weeks) and overall survival. Results In total, 45 cases (42 twin and three triplet pregnancies) underwent RFA and 126 cases (105 twin and 21 triplet pregnancies) underwent MWA. The overall survival rates in monochorionic diamniotic twin pregnancies were similar between the RFA and MWA groups (61.0% vs 67.0%; P = 0.494). However, pregnancies whose indication for fetal reduction was selective intrauterine growth restriction or twin reversed arterial perfusion had higher overall survival rates (75.5% and 82.6%, respectively) compared with those in other indication groups. A total of 104 children were followed up (20 in the RFA group and 84 in the MWA group); four (20.0%) and eight (9.5%) children were assessed as having overall developmental delay in the RFA and MWA groups, respectively, with no significant difference between the two groups. Multivariable analyses showed that procedure indication, number of ablation cycles and gestational age at procedure were associated significantly with the main perinatal outcomes. Conclusions RFA and MWA for selective fetal reduction in complicated monochorionic pregnancies can achieve similar overall survival rate and neurodevelopmental outcome, but MWA is associated with a lower risk of preterm birth. Moreover, procedure‐related factors are associated significantly with perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

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“…10 Gaerty et al demonstrated a lower overall survival rate in both the BCO (79.1%) and RFA (76.8%) groups. 9 We added several reasonably large case series incorporating RFA, 22,23,32,33,[35][36][37]24,32,35,38 and FLC 5,28,39 patients, and included MWA and ILC in our analysis. The overall survival rates for the BCO (79.2%) and RFA (77.5%) groups in our analysis were similar to Gaerty et al, 9 but lower than in Rossi et al 10 The FLC (78.8%) and UCL (76.5%) groups showed higher overall survival rates in our analysis than in Rossi et al 10 The PPROM rate was reported as 28.2%…”

Section: Discussionmentioning

confidence: 99%

Perinatal outcomes after selective feticide via umbilical cord occlusion in complicated monochorionic pregnancies: A systematic review and meta‐analysis

Chen

Yin

et al. 2021

Prenatal Diagnosis

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Objective: We aimed to compare perinatal outcomes between umbilical cord occlusion techniques in monochorionic pregnancies, including umbilical cord ligation, fetoscopic laser coagulation, interstitial laser coagulation, bipolar cord occlusion, radiofrequency ablation, and microwave ablation. Methods:This study was registered with PROSPERO (CRD42020158861).PubMed, Web of Science, Cochrane Library, and Embase were searched for studies published up to May 2020. The DerSimonian-Laird random-effects model was used for the meta-analysis. Subgroup analyses were performed to compare the outcomes among the six techniques. Meta-regression was used to adjust for confounders. Results:Thirty-four studies with 1646 participants were included. The overall survival was 76.5% after umbilical cord ligation, 78.8% after fetoscopic laser coagulation, 60.3% after interstitial laser coagulation, 79.2% after bipolar cord occlusion, 77.5% after radiofrequency ablation, and 75.0% after microwave ablation.Subgroup comparison showed the rates of overall survival and preterm premature rupture of membranes were not significant different among six techniques. However, rates of fetal loss, premature birth, live birth, and neonatal death differed significantly among the six groups. Conclusions:The choice of umbilical cord occlusion techniques will affect perinatal outcomes. We suggested that the choice of umbilical cord occlusion techniques should fully consider these differences among techniques. Key pointsWhat's already known about this topic? � Several techniques have been used for selective feticide of monochorionic pregnancies.� Bipolar cord occlusion and radiofrequency ablation are two commonly used minimally invasive methods for selective feticide.� However, whether the pregnancy outcomes are different among different techniques is still unknown. What does this study add?� This is the first meta-analysis comparing perinatal outcomes among six techniques of selective feticide in monochorionic pregnancies.

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Selective fetal reduction in monochorionic twins: Preliminary experience

Cited by 14 publications

References 11 publications

Success Rate and Perinatal Outcomes of Selective Reduction by Radiofrequency Ablation in Monochorionic Multiple Pregnancies with a Hydropic Fetus; A Prospective Interventional Single-Arm Study

Success Rate and Perinatal Outcomes of Selective Reduction by Radiofrequency Ablation in Monochorionic Multiple Pregnancies with a Hydropic Fetus; A Prospective Interventional Single-Arm Study

Perinatal and neurodevelopmental outcome in complicated monochorionic pregnancy after selective fetal reduction: radiofrequency ablation vs microwave ablation

Perinatal outcomes after selective feticide via umbilical cord occlusion in complicated monochorionic pregnancies: A systematic review and meta‐analysis

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