Perinatal Survival Rate Research Articles

Expectant management of severe preeclampsia with severe fetal growth restriction in the second trimester

We investigated whether women with severe fetal growth restriction (FGR <5th percentile) associated with severe preeclampsia (PE) occurring in the second trimester are candidates for expectant management. This is a retrospective study involving 33 women who developed severe PE or superimposed PE in the second trimester and were expectantly managed at a tertiary center. They were divided into groups with and without severe FGR on admission (severe FGR (+) group: 17 women; severe FGR (-) group: 16 women) for comparison of the duration of pregnancy prolongation, major maternal complications, and perinatal outcomes. The data are presented as medians (range) or frequencies (percentage). The duration of pregnancy prolongation was 10days in both groups. Major maternal complications occurred in 5 of 17 women (29.4%) in the severe FGR (+) and 5 of 16 (31.3%) in the severe FGR (-) group, showing very similar incidence rates in the 2 groups. The perinatal survival rates were favorable at 82.4% (14/17) in the severe FGR (+) and 100% (16/16) in the severe FGR (-) group. Regarding expectant management of severe preeclampsia occurring in the second trimester, there was no difference in the duration of pregnancy prolongation between the groups with and without severe FGR on admission. Because favorable perinatal outcomes can be expected without compromising maternal safety by prolonging pregnancy as expectant management for severe FGR, it was suggested that women with severe FGR are suitable candidates for expectant management.

Improving the management and outcome in haemolytic disease of the foetus and newborn.

Improving the management and outcome in haemolytic disease of the foetus and newborn.

Long‐term neurodevelopmental and cardiovascular outcome after intrauterine transfusions for fetal anaemia: a review

Perinatal survival rates after intrauterine transfusions (IUT) for red cell alloimmunisation now exceed 90%, which demonstrates the safety and efficacy of one of the most successful procedures in fetal therapy. However, improved perinatal survival could lead to an increased number of children with long-term disabilities. The importance of long-term follow-up studies in fetal therapy lies in both the necessity of evaluation of antenatal management as well as in evidence-based preconceptional and prenatal counselling. This review describes the possible long-term cardiovascular and neurodevelopmental sequelae after IUT treatment for different indications including red cell alloimmunisation, parvovirus B19 infection, fetomaternal haemorrhage and twin anaemia-polycythaemia sequence.

Perinatal outcome after selective feticide in monochorionic twin pregnancies

To evaluate the incidence and risk factors of adverse perinatal outcome in complicated monochorionic twin pregnancies treated with selective feticide. This was a retrospective analysis of prospectively collected data from a consecutive, national cohort. All monochorionic twin pregnancies treated with selective feticide at Leiden University Medical Center between June 2000 and November 2011 were included. Obstetric and neonatal data were recorded. The primary outcome measure was adverse perinatal outcome, including fetal or neonatal demise or severe neonatal morbidity. Data on perinatal outcome were obtained in all cases (n = 131). Overall perinatal survival rate was 67.2% (88/131). Median gestational age at delivery was 34 (interquartile range, 23-38) weeks. Neonatal mortality and morbidity rate in liveborn children was 4.3% (4/92) and 12.0 % (11/92), respectively. Severe cerebral injury was detected in three children. The overall incidence of adverse perinatal outcome was 41.2% (54/131). Median gestational age at occurrence of preterm prelabor rupture of membranes (PPROM) was 19.0 weeks and 32.0 weeks in cases with and without adverse perinatal outcome, respectively (P = 0.017). Liveborn children with adverse perinatal outcome were born at a lower median gestational age (29.0 weeks) than were children without adverse perinatal outcome (38.0 weeks) (P < 0.001). The risk of adverse perinatal outcome after selective feticide is high and associated with low gestational age at occurrence of PPROM and low gestational age at delivery. Long-term follow-up to assess neurodevelopmental outcome in survivors is required.

Treatment of twin to twin transfusion syndrome – comparison of two therapeutic methods – amnioreduction and lasertherapy

Twin to twin transfusion syndrome occurs in 15% of monochorionic twin pregnancies. Untreated, TTTS has been reported to have a mortality of nearly 100%. Two main therapies include serial amnioreduction and fetoscopic laser coagulation for the vascular anastomoses. The aim of the project was to investigate the optimal diagnostic and therapeutic procedure in pregnancies complicated by TTTS. Additionally the study was supposed to compare non-invasive and invasive methods of treatment and to show antenatal and postnatal follow - up to 4 months of age. 42 pregnant women with twin-to-twin transfusion syndrome were assigned to laser therapy using diode laser and 33 pregnant women underwent only several amnioreductions. Selected parameters characterizing the pregnancy were compared in both groups. In the amnioreduction group, the perinatal survival rate seven days after the delivery was 31.8%. The survival rate of at least one twin was 39.4%. As compared to the amnioreduction group, in the laser group the survival rate of at least one twin was observed in 31 cases (31/42) and it was equal to 74%. Neurological complications in the amninoreduction group were observed in 19% (4/21) of cases, in the laser group and in 5% (2/40) of neonates at 4 months of age. Currently the preferred and only method that addresses the cause of the disease is the endoscopic laser coagulation of anastomoses. Comparison of the two treatments shows better outcomes with higher survival rates and minor neurological defects in cases treated with laser coagulation.

A nomogram for perioperative prognostic risk‐assessment in twin–twin transfusion syndrome

Prognostic assessment in twin-to-twin transfusion syndrome (TTTS) is ill-defined. The objective of this study is to define a perioperative prognostic score for TTTS treated by percutaneous laser coagulation. Consecutive cases of TTTS treated by percutaneous fetoscopic laser coagulation over a 6-year period were reviewed. Twin survival at 28 days was considered using a 3-level polytomous variable defined by 0, 1, or 2 fatal events. A multivariate prognostic analysis with internal validation was conducted using gestational age at diagnosis, weight discordance, umbilical artery, and ductus venosus abnormalities in the donor and the recipient respectively, cervical length, selectivity of surgery, and transplacental approach. On the basis of 507 cases, the perinatal survival rate of 2 and 1 twin was 46.2% and 31.5%, respectively. Statistically significant factors included umbilical artery abnormalities in the donor, gestational age, and transplacental approach, but with different effects regarding survival of 0, 1, or 2 twins. A scoring chart was subsequently constructed together with a nomogram for both a preoperative and immediate post-operative prognostic assessment. Part of the prognosis can be anticipated by perioperative findings. Although further validation is required, the presented nomogram should help unify the prognostic assessment in TTTS.

Ovine mitochondrial DNA sequence variation and its association with production and reproduction traits within an Afec-Assaf flock1

Polymorphisms in mitochondrial DNA (mtDNA) protein- and tRNA-coding genes were shown to be associated with various diseases in humans as well as with production and reproduction traits in livestock. Alignment of full length mitochondria sequences from the 5 known ovine haplogroups: HA (n = 3), HB (n = 5), HC (n = 3), HD (n = 2), and HE (n = 2; GenBank accession nos. HE577847-50 and 11 published complete ovine mitochondria sequences) revealed sequence variation in 10 out of the 13 protein coding mtDNA sequences. Twenty-six of the 245 variable sites found in the protein coding sequences represent non-synonymous mutations. Sequence variation was observed also in 8 out of the 22 tRNA mtDNA sequences. On the basis of the mtDNA control region and cytochrome b partial sequences along with information on maternal lineages within an Afec-Assaf flock, 1,126 Afec-Assaf ewes were assigned to mitochondrial haplogroups HA, HB, and HC, with frequencies of 0.43, 0.43, and 0.14, respectively. Analysis of birth weight and growth rate records of lamb (n = 1286) and productivity from 4,993 lambing records revealed no association between mitochondrial haplogroup affiliation and female longevity, lambs perinatal survival rate, birth weight, and daily growth rate of lambs up to 150 d that averaged 1,664 d, 88.3%, 4.5 kg, and 320 g/d, respectively. However, significant (P < 0.0001) differences among the haplogroups were found for prolificacy of ewes, with prolificacies (mean ± SE) of 2.14 ± 0.04, 2.25 ± 0.04, and 2.30 ± 0.06 lamb born/ewe lambing for the HA, HB, and the HC haplogroups, respectively. Our results highlight the ovine mitogenome genetic variation in protein- and tRNA coding genes and suggest that sequence variation in ovine mtDNA is associated with variation in ewe prolificacy.

Benefits and risks of expectant management of severe preeclampsia at less than 26 weeks gestation: the impact of gestational age and severe fetal growth restriction

To determine maternal and perinatal outcome in women with severe preeclampsia at <26 weeks according to gestational age at the onset of expectant management and the presence of severe fetal growth restriction (<5th percentile). Fifty-one patients (53 fetuses; 2 twins) were retrospectively studied. Median prolongation was 7 days (2-55). Maternal morbidity rate was 43%. Perinatal survival rate was 42%. Severe fetal growth restriction complicated 17 fetuses (33%). There were no perinatal survivors in those managed at <24 weeks (n = 12). For those at 24-24(6/7) and 25-25(6/7) weeks, the perinatal survival rates were 50% and 57%, respectively, and in the presence of severe fetal growth restriction 0% and 30%, respectively. Perinatal outcome in severe preeclampsia in the midtrimester is dependent on gestational age and/or the presence of severe fetal growth restriction. Given the high maternal morbidity and the extremely low perinatal survival rates, we do not recommend expectant management before 24 weeks and/or in those with severe fetal growth restriction at any gestational age <26 weeks.

Coagulation laser en fœtoscopie des anastomoses vasculaires placentaires : étude observationnelle de 100 grossesses gémellaires monochoriales consécutives compliquées de syndrome transfuseur-transfusé sévère

To report pre- and post-surgical datas of large series of severe twin-to-twin transfusion syndrome (TTTS) managed with laser ablation surgery in our centre, to evaluate the incidence of complications, perinatal outcome and to compare with other cohorts. Observational study of 100cases of TTTS consecutively treated with fetoscopic laser coagulation between January2004 and April2010 in CMCO-SIHCUS of Schiltigheim. There are nine stageI, 49 stageII, 38 stageIII and four stage4. Median gestation at time of laser is 20.6weeks (14-29) whereas median gestation at delivery is 32.6weeks (16.3-39). Overall perinatal survival rate is 68.5% (137children over 200). Eighty-five percent have one or more surviving twins. The survival rate is the same for donors and for recipients. Preterm premature rupture of the membranes are observed in 17% of cases and the median gestational age for this complication is 30weeks (20-34). Cerebral abnormalities are present in 7% of newborns. Our results for the management of severe TTTS are comparable to the other reported series. There are still many questions remaining concerning the optimal management of TTTS.

Short-term and long-term outcomes of 214 cases of non-immune hydrops fetalis

Despite advances in diagnosis and management, non-immune hydrops fetalis (NIHF) has a high mortality rate. Perinatal survival depends on the underlying disorder and the gestational age at diagnosis. As prognostic information is limited, this study acquired data regarding the neurological development of perinatal survivors. We performed a retrospective chart review of 214 cases in which NIHF was diagnosed antenatally. We recorded maternal demographic characteristics and interventions and their effectiveness, as well as the short-term outcome (survival) and long-term outcome including developmental quotients. Among the affected fetuses, 91 (42.5%) survived the perinatal period. Fetuses with chylothorax, chyloascites, or meconium peritonitis, and those in whom therapy was effective, had high survival rates irrespective of the type of intrauterine intervention. The subsequent intact survival rate was 28/56 (50.0%), with intact defined as ratio of the number of infants with normal development to the number of all infants followed. In contrast to the perinatal survival rate, the intact survival rate decreased as gestational age at diagnosis advanced. These findings suggest that the long-term intact survival rate depends on the underlying cause of NIHF. Additionally, while survival was improved with intensive perinatal care during the perinatal period, aggressive perinatal intervention was not a prognostic factor for neurological outcome.

The relationship between the classification of early onset secere preeclampsia and perinatal outcomes

Objective To investigate the relationship between the classification of early onset secere preeclampsia and perinatal outcomes. Methods 80 patients with S-PE were divided into two groups;Early onset of S-PE (group A) 14 cases (onset≤ 34 weeks) and late onset of S-PE (group B) 66 cases (onset ＞34 weeks). The clinical data,complications,perinatal outcome and placental inhibin A,placenta activin A were compared. Results Among 80 cases with S-PE, 14 cases(17.5% ) in group A were significantly lower than the 66 cases(82.5% ) in group B( x2 = 3.989, P ＜ 0.05) ;The complication rate of 14 cases (100. 0% ) in group A were significantly higher than 18 cases (27. 3% ) in group B(x2 =3.989,P＜0.05) ;The perinatal survival rate of 27.3% in group A was significantly lower than 79.3% in group B(x2 = 3.789,P＜0. 01) ;The expression of placental inhibin A and placenta activin(589. 24 ± 16.96),(485.06 ±17. 58) in group A were significantly higher than (459. 36 ± 13. 05) , (338. 29 ± 11.23) in group B( t - 2.424,2.439, P ＜ 0.05) ; The expression of placental inhibin A and placenta activin with 24h urine protein(24h) were positively correlated(r = 0.62,0.59,all P＜0.05). Conclusion Early onset with S-PE were attacked abruptly and serious complications. It was significantly associated with poor maternal and perinatal outcomes. Key words: Pre-eclampsia; Pregnancy outcome,Early onset type; Late onset type

Haemodynamic effects of long-term administration of sildenafil in normotensive pregnant and non-pregnant rats

To determine the effects of chronic administration of sildenafil citrate on healthy pregnant rats. In vivo animal experimental study. Fundación IVI-Instituto Universitario IVI, Valencia, Spain. Pregnant and non-pregnant Wistar rats exposed to chronic administration of sildenafil. Placental cross-barrier and feto-maternal relationship levels, maternal blood pressure, and haemodymamic effects on uterine arteries were evaluated. The effect of growth on weight and fetal tissues, and on perinatal outcome, was investigated. Maternal blood pressure, blood viscosity, vascular indices of uterine arteries and fetal ductus venosus, plasmatic levels of sildenafil, embryo/fetal and litter weights, perinatal/postnatal survival rates. Sildenafil citrate crossed the placenta. The maternal and fetal levels of sildenafil, and its metabolite desmethyl-sildenafil, demonstrated a positive linear correlation in treated pregnant animals versus controls; a selective maternal hypotensive effect without changes in uterine vascular resistance was noted on days E8 and E11 (embryonic day). The lower pulsatility index of the ductus venosus on day E18 suggests fetal overflow at the end of the pregnancy. Effects on offspring were placental and liver enlargement, and increased fetal weight gain in the second half of pregnancy (irrespective of liver enlargement) and at birth. Perinatal and postnatal survival rates in the sildenafil group remained unaltered. No haemodynamic effects were evident in non-pregnant animals. In normotensive rats, sildenafil appears to have a selective effect at the onset of pregnancy, implying increased fetal blood supply, and increased fetal weight, and placental and liver enlargement, but no increased perinatal mortality.

758: Benefits and risks of expectant management of severe preeclampsia at less than 26 weeks gestation: the impact of gestational age and severe fetal growth restriction

758: Benefits and risks of expectant management of severe preeclampsia at less than 26 weeks gestation: the impact of gestational age and severe fetal growth restriction

Pregnancy complicating systemic lupus erythematosus: a series of 86 cases

To investigate the timing of pregnancy and pregnancy termination and its management in women with pregnancy complicating systemic lupus erythematosus (SLE). A series of 86 cases of pregnancy complicating SLE treated in our hospital from January 2005 to June 2010 were retrospectively reviewed, including 54 cases of planned pregnancy and 32 cases of unplanned pregnancy. The pregnancy courses and clinical outcomes were analyzed. While 12 patients in planned pregnancy group showed active SLE during pregnancy, all 32 patients in the unplanned pregnancy group presented severe SLE complications. The incidences of pregnancy loss, preterm delivery and neonatal asphyxia in the unplanned pregnancy group were significantly higher than planned pregnancy group (P < 0.05), and the infant body weight was lower in the unplanned pregnancy group (P < 0.05). A total of 78 live infants were born and no mortality was reported, including 15 preterm infants and one neonatal SLE. Planned pregnancy during stable stage, appropriate treatment in pregnancy and close monitoring can improve the security of pregnancy complicating SLE. In situations that the drug treatment is ineffective and the mother and infant are threatened, or the fetus is mature, the pregnancy should be terminated promptly, thereby reducing the complications, and increasing the success rate of pregnancy and perinatal survival rate.

Neurodevelopmental outcome and risk factors for disability for twin-twin transfusion syndrome treated with laser surgery

This study was performed to report the neurodevelopmental outcome of survivors of twin-twin transfusion syndrome (TTTS) treated with laser surgery and to determine the risk factors for neurodevelopmental disability. A prospective study of TTTS cases treated with laser was performed. Survivors were assessed at 2 years corrected for prematurity. Neurodevelopmental disability was defined as the presence of cerebral palsy, deafness, blindness, or cognitive impairment with a developmental score >2 SDs below the mean. A total of 75 TTTS pregnancies were treated with a perinatal survival rate of 79.3%. A total of 113 survivors were assessed. The rate of cerebral palsy was 4.4% and cognitive impairment was 8%, with a neurodevelopmental disability rate of 12.4%. Quintero stage was the only independent risk factor for neurodevelopmental disability. The incidence of neurodevelopmental disability in TTTS survivors treated with laser is considerable, with Quintero stage being an independent risk factor.

Effects of gestational age on perinatal outcomes in patients complicated with early onset severe preeclampsia

To analysis the relationship between gestational age and perinatal outcomes in patients complicated with early onset severe preeclampsia. Retrospective study was conducted on clinical documents of 221 patients with early onset severe preeclampsia (< 34 weeks) who delivered after 28 gestational weeks in Peking University First Hospital from July 1999 to June 2009. Patients were divided into three groups based on gestational weeks at delivery: group I (n = 81) delivered at 28 - 31 weeks(+6), group II (n = 78) at 32 - 33 weeks(+6) and group III (n = 62) after 34 weeks. The clinical characteristics and perinatal outcomes were compared among those three groups. (1) Outcome of neonates: Among 221 neonates, 13 neonates lost follow-up, including 9 in group I, 3 in group II, 1 in group III. The incidence of neonatal respiratory distress syndrome (RDS) of 26% (19/72) in group I were significantly higher than 7% (5/75) in group II and 10% (6/61) in group III (P < 0.05). The neonatal mortality rate of (43%, 31/72) in group I were significantly higher than 3% (2/61) in group III and 28% (21/75) in group II (P < 0.05). The incidence of maternal complications showed no statistical difference among three groups. (2) Neonatal death analysis: all neonatal death were due to parents' give up, including 26% (8/31) in group I, 67% (14/21) in group II and 1/2 in group III, which reached statistical difference (P < 0.05). The incidence of neonatal RDS in mother with early onset severe preeclampsia was decreased if delivered after 32 weeks, and the perinatal mortality was remarkably decreased if delivered after 34 weeks. Therefore, the perinatal survival rate in women with early onset severe preeclampsia can be improved by minimizing the impact of social factors.

1220 The Perinatal Mortality in Leto' Maternity Hospital Nicu During 20072009, and Survival of Newborn Infants with Bw ≤ 1500 Grams

Background and aims: Recording the survival of newborns in any Maternity Hospital is of utmost importance, as it contributes to the understanding of the level of perinatal care in Greece. The aim is to present evidence about perinatal mortality and survival rate of very low birth weight (VLBW) neonates (birth weight (BW)≤ 1,500 grams) at the NICU at Leto Maternity Hospital. Methods: Neonates transferred to other hospitals, admissions in Leto's NICU, perinatal mortality and neonatal survival (BW≤1,500 grams), were recorded and documented during 2007 to 2009. Results: In 2007, 744 neonates admitted in the NICU, 37 with BW ≤ 1,500 grams (11 with BW=500- 1,000 grams and 26 with BW=1,001-1,500 grams). Five were transferred to other hospitals (three for financial reasons and two needed surgical operation treatment). In 2008, 908 neonates admitted in the NICU, 40 with BW≤ 1,500 grams (17 with BW=500- 1,000 grams and 23 with BW=1,001-1,500 grams). Six were transferred to other hospitals (three needed intestinal surgery treatment, and three with posthemorrhagic hydrocephalus). In 2009, 911 newborns admitted in the NICU, 45 with BW ≤ 1,500 grams (15 with BW=500-1,000 grams and 30 with BW=1,001-1,500 grams). Four were transferred to other hospitals (two for financial reasons and two with posthemorrhagic hydrocephalus). 11 early fetal deaths were recorded (3, 3, and 5 for each year respectively) but no late neonatal fatalities (Table 1). Conclusions: The survival of VLBW neonates is considered to be equal to other European Union countries.

Early intrauterine transfusion in severe red blood cell alloimmunization

To determine perinatal outcome in pregnancies with early severe red blood cell (RBC) alloimmunization. This was a retrospective analysis of 30 patients requiring their first intrauterine transfusion (IUT) at < 22 weeks of gestation. Timing of the first IUT was based on evaluation of either the middle cerebral artery peak systolic velocity (MCA-PSV) or development of ascites. Thirty-three per cent of the patients had experienced a previous intrauterine fetal death as a result of RBC alloimmunization. Of these alloimmunized pregnancies, 26 (87%) were associated with anti-D, four (13%) with anti-Kell and 12 had more than one antibody type involved. The antibody titers before the first IUT ranged from 1:128 to 1:8024. All fetuses were severely anemic before the first IUT with a median hemoglobin (Hb) level of 37 (range, 3-81) g/L. The nine hydropic fetuses had a lower Hb level compared with non-hydropic fetuses (median 15 g/L vs. 42 g/L, P = 0.016). However, 15 (71%) non-hydropic fetuses had an Hb level of < 50 g/L before the first IUT. The median gestational age at the first IUT was 20.4 (range, 16-22) weeks, and between one and nine transfusions were needed during pregnancy. Transfusion was via the intrahepatic vein (IHV) (n = 19), umbilical vein (n = 6) or umbilical artery (n = 2), or was intracardiac (n = 2) or intraperitoneal (n = 1). Overall perinatal survival rate was 80% and did not differ between hydropic and non-hydropic fetuses. Median gestation at delivery, after exclusion of six intrauterine fetal deaths, was 36.7 (range, 27.8-38.4) weeks. In early severe RBC alloimmunization, fetuses can be severely anemic without hydrops, and prognosis cannot be predicted by the presence or absence of hydrops. Early IUT followed by serial transfusions is associated with a perinatal survival rate of about 80%.

Early onset pregnancy-induced hypertension/eclampsia in Benin City, Nigeria.

Pregnancy - induced hypertension/eclampsia is a major cause of maternal and perinatal morbidity and mortality in Nigeria. There have been very few studies focused on early onset pregnancy induced hypertension/eclampsia in Nigerian women. To determine the incidence, clinical features and outcome of cases of early onset pregnancy-induced hypertension /eclampsia in a Nigerian tertiary hospital, and compare maternofetal outcome in early and late onset disease. Methods : A retrospective study of all cases of early onset pregnancy induced hypertension/eclampsia seen over a five-year period in a tertiary hospital. Severity of disease, rates of induction of labour, caesarean section rate, maternal mortality, abruptio placenta, still births, severe birth asphyxia and early neonatal deaths. Early onset pregnancy induced hypertension/eclampsia contributed 6.3% of all cases of hypertensive disorders in pregnancy with an incidence of 1:141 deliveries. Most cases presented at between 28-32 weeks gestation (78.3%) The disease was severe at presentation or rapidly progressive in 39 cases (84.8%) leading to delivery within 72 hours of presentation. Caesarean section was the mode of delivery in 58.7% of cases. The perinatal survival rate was 34.0%. Early onset pregnancy induced hypertension was associated with significantly higher risk of presenting with eclampsia, having induction of labour and worse perinatal outcome than late onset disease. Most cases of early onset pregnancy induced hypertension in the study population presented with severe and rapidly progressive disease and were associated with significantly higher risk of obstetric intervention and worse perinatal outcome than late onset disease.

Fetal reduction by bipolar cord coagulation in managing complicated monochorionic multiple pregnancies: preliminary experience in China

Background Monochorionic multiple pregnancies (MMPs) are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs. Methods Using ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs (5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction). One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different indications. Data regarding the operations, complications and neonatal outcomes were analyzed. Results Cord occlusions were successfully performed in 13/14 (93%) cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 (85%). Three operation-related complications occurred (21%), including membrane rupture of the terminated sac (1 case), preterm labor at 28 weeks gestation (1 case), and chorioamniotic membrane separation (1 case). Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin. Conclusions The application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited.