OP25.02: Experience of selective reduction by radiofrequency ablation in complicated monochorionic twin pregnancy between 2007 and 2016

Abstract

The primary objective of this study was to evaluate our experience in the treatment of complicated monochorionic pregnancy requiring selective reduction, and to assess the efficacy of radiofrequency ablation (RFA) for selective fetal reduction. This is a retrospective observational study of 34 complicated monochorionic pregnancies undergoing RFA at CHU Ste-Justine in Montréal from 2007 to 2016. Descriptive statistics were performed. 34 cases of complicated monochorionic twin pregnancies were identified. A 17-Gauge Leveen needle was used in all cases. The leading indications were Twin–twin transfusion syndrome stage 3 or more in 17.6% (6/34), severe intrauterine growth restriction in 38.2% (13/34), twin reversed arterial perfusion sequence in 20.6% (7/34) and discordant fetal anomalies in 23.5% (8/34). The procedure was successful with a single entry in all cases. The mean duration of the procedure was 21 minutes. Transplacental passage occurred in 38.2%. In 29.4% of RFA, another prenatal technique was performed. Most cases were performed under local analgesia (n=28). We observed no separation of membrane or bleeding during the procedure. Most patients received prophylactic tocolysis with Indometacin (n=32). All patients received prophylactic antibiotics. No one presented fever after the procedure nor needed blood transfusion. The mean gestational age at the time of the procedure was 21weeks. (+/-2.2). The delay between the procedure and the birth was 101 days (7-153 days). The mean gestational age at birth was 33+4 (+/-5). No brain lesions were observed in the prenatal or neonatal period. There were 29.2% of PPROM. Preterm labour occurred in 16.7% of cases. We observed one case of placental abruption at 28 wks and 1 case of stillbirth at 20 weeks. From all cases, 76.2% were born by vaginal delivery and 33.3% by Caesarean section. RFA appears to be a safe and effective technique for selective reduction. Our experience demonstrated a 97% overall survival rate.