Selective reduction in complicated monochorionic twins: prediction of obstetric outcome and comparison of techniques

Abstract

Objectives To compare the outcomes of radiofrequency ablation (RFA)

Comparison of umbilical cord occlusion methods: Radiofrequency ablation versus laser photocoagulation

“…Selective termination of the anomalous twin using umbilical cord occlusion (UCO) is associated with decreased morbidity and mortality of the unaffected co‐twin . UCO has been performed via a variety of methods, including through bipolar cord coagulation, cord suture ligation, radiofrequency ablation (RFA), and fetoscopic‐guided laser photocoagulation of umbilical vessels . The optimal method of UCO is undetermined.…”

Ultrasound-Guided Bipolar Umbilical Cord Occlusion in Complicated Monochorionic Pregnancies: Is There a Learning Curve

“…Based on this, UCO may in some cases of TTTS be the treatment most likely to enhance the chances of a healthy live-born baby. A few studies have been published on the comparison of techniques for cord occlusion [14][15][16]. The technique of ultrasound-guided UCO for selective feticide in MC cases was developed by several large centers in the late 1990s [17][18][19][20] and was introduced at the Center of Fetal Medicine, Rigshospitalet in [2003][2004].…”

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

“…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.…”

“…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.…”

“…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]. …”