Radiofrequency ablation for selective fetal reduction in complicated Monochorionic twins; comparing the outcomes according to the indications

Fatemeh Rahimi-Sharbaf,Marjan Ghaemi,Alireza A Shamshirsaz,Mahboobeh Shirazi,Ahmed A Nassr

doi:10.1186/s12884-021-03656-1

Abstract

BackgroundTo evaluate the perinatal outcomes in women with complicated monochorionic diamniotic twins who underwent selective reduction using radiofrequency ablation (RFA).MethodsThis retrospective study included patients with complicated monochorionic diamniotic twins between 16 to 28 weeks who underwent selective reduction using RFA.ResultsDuring the study period, 143 women with complicated monochorionic twins underwent RFA including 52 with selective fetal growth restriction (sFGR), 48 with twin to twin transfusion syndrome (TTTS), 33 with major fetal anomalies in one of the twins, and 10 with reversed arterial perfusion sequence (TRAP). The overall survival was 71.3% (102/143). The procedures were technically successful in achieving selective termination in all cases. The mean ± SD of gestational age at the time of the procedure was 21.0 ± 2.3 weeks. The mean ± SD of gestational age at delivery was 34.6 ± 3.3 weeks. The mean ± SD of overall procedure-to-delivery time was 12 ± 1.7 weeks. The pregnancy success rates among sFGR, TRAP, TTTS and anomaly groups were 82.7, 80, 73 and 60.7% respectively. There were no maternal complications.ConclusionRadiofrequency ablation for fetal reduction in complicated monochorionic twin pregnancies appears to be a reasonable option. The pregnancy success rate following RFA selective reduction was highest among sFGR and TRAP groups and lowest in the anomaly group.

Highlights

IntroductionMonochorionic twins are associated with specific complications due to placental sharing including higher risk of fetal growth restriction, twin-twin transfusion syndrome (TTTS), early preterm delivery and perinatal
Monochorionic twins are associated with specific complications due to placental sharing including higher risk of fetal growth restriction, twin-twin transfusion syndrome (TTTS), early preterm delivery and perinatalThese conditions may cause death of the most affected twin and severe morbidity or mortality of the co-twin
We describe the perinatal outcomes of 143 consecutive cases of complicated monochorionic twin pregnancies that underwent selective reduction with radiofrequency ablation (RFA) at our institution according to the indications for the intervention

Summary

Introduction

Monochorionic twins are associated with specific complications due to placental sharing including higher risk of fetal growth restriction, twin-twin transfusion syndrome (TTTS), early preterm delivery and perinatal. These conditions may cause death of the most affected twin and severe morbidity or mortality of the co-twin. Some parents may choose to terminate the pregnancy because of the high risk of perinatal morbidity and mortality in both twins [3]. Selective feticide is one of the treatment options to minimize the potential neurological injuries and to improve the chances of survival of the normal co-twin in complicated monochorionic pregnancies [4, 5]. To evaluate the perinatal outcomes in women with complicated monochorionic diamniotic twins who underwent selective reduction using radiofrequency ablation (RFA)

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Discussion

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