Radiofrequency ablation and bipolar umbilical cord coagulation for complicated monochorionic twins

Abstract

Objective To assess the effects of radiofrequency ablation (RFA) and bipolar cord coagulation (BCC) on the prognosis and complication rate of complicated monochorionic twins. Methods A retrospective review was undertaken in 58 cases of complicated monochorionic twins treated with RFA or BCC at the First Affiliated Hospital of Sun Yat-Sen University, from January 2008 to August 2013. Non-parametric Wilcoxon test, Chi-square test, Fisher exact test or multi-variant Logistic regression analysis were used for statistical analysis. Results Indications for selective termination in the 58 cases were: twin reversed arterial perfusion sequence in 12, severe twin to twin transfusion syndrome in 28, discordance of fetal anomalies in 10, selective intrauterine growth restriction in 7 and twin anemia-polycythemia sequence in 1. Forty-three cases were managed with BCC and 15 with RFA. Preterm labor was more common in the BCC group than in the RFA group [86.0%(37/43) vs 9/15, respectively; χ2=4.598, P=0.032). Premature rupture of the membranes occurred in 48.8%(27/43) of the BCC group vs. 4/15 of the RFA group (χ2=2.229, P=0.135). The median procedure-to-delivery time was 48 (1-150) days for the BCC group vs. 101(14-138) days for the RFA group (Z=-2.245, P=0.025). Overall survival rate was 62.8%(27/43) in the BCC group vs 11/15 in the RFA group (χ2=0.547, P=0.460), which was not significantly different. Neurodevelopmental delay was detected in two neonates in BCC group and in one neonate in RFA group. Logistic regression analysis showed that delivery before 28 gestational weeks was an independent risk factor for the poor prognosis of the co-twins (OR=192.720, 95%CI: 18.610- 994.000, P<0.01). Conclusion Compared with BCC, RFA does not improve the prognosis of complicated monochorionic twins significantly. Key words: Pregnancy, twin; Pregnancy reduction, multifetal; Catheter ablation; Electrocoagulation; Umbilical cord; Prognosis