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.

Fatemeh Rahimi Sharbaf,Sakineh Mirzaei Khalilabadi,Mahboobeh Shirazi,Mamak Shariat,Marjan Ghaemi,Mansooreh Haghiri,Shirin Niroomanesh

doi:10.34172/aim.2022.02

Abstract

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. 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. 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. 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.

Highlights

Twin pregnancy occurs in 3% of all births.[1,2] During the recent decades, the prevalence of twin pregnancy has been dramatically increased according to high maternal age, and widespread use of ART as the main reasons.[2-4]
27 complicated monochorionic twin and triplet pregnancies underwent radiofrequency ablation (RFA) to occlude the umbilical vein of the hydropic fetus
The gestational age at delivery in to-Twin Transfusion Syndrome (TTTS)-induced hydrops was significantly lower than the non-TTTS hydrops group (P = 0.003)

Summary

Introduction

Twin pregnancy occurs in 3% of all births.[1,2] During the recent decades, the prevalence of twin pregnancy has been dramatically increased according to high maternal age, and widespread use of ART (assisted reproductive technique) as the main reasons.[2-4]. 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. 27 complicated monochorionic twin and triplet pregnancies underwent RFA to occlude the umbilical vein of the hydropic fetus. 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.

Methods

Results

Conclusion