Outcome of radiofrequency ablation for selective fetal reduction before vs at or after 16 gestational weeks in complicated monochorionic pregnancy

• Published in: Ultrasound in obstetrics & gynecology 2021-08, Vol.58 (2), p.214-220
• Main Authors: Ting, Y. H., Poon, L. C. Y., Tse, W. T., Chung, M. Y., Wah, Y. M., Hui, A. S. Y., Law, K. M., Chaemsaithong, P., Leung, T. Y.
• Format: Article
• Language: English
• Subjects: Adult; discordant fetal anomaly; Female; Gestational Age; Humans; Infant, Newborn; monochorionic; multiple pregnancy; Postoperative Complications; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy Trimesters; Pregnancy, Multiple; Radiofrequency Ablation; Retrospective Studies; selective fetal growth restriction; selective fetal reduction; sFGR; TAPS; TRAPS; TTTS; twin anemia–polycythemia sequence; twin reversed arterial perfusion sequence; twin‐to‐twin transfusion syndrome
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.22160

ABSTRACT Objective To investigate whether gestational age at intervention (< or ≥ 16 weeks) and other factors affect the risk of loss of the cotwin after selective fetal reduction using radiofrequency ablation (RFA) in monochorionic (MC) pregnancy. Methods This was a single‐center retrospective analysis of 63 consecutive RFA procedures performed at our institution from January 2011 to October 2019 for selective fetal reduction in complicated MC pregnancies. Indications for RFA were twin reversed arterial perfusion sequence (13 cases), twin‐to‐twin transfusion syndrome (12 cases), twin anemia–polycythemia sequence (two cases), selective fetal growth restriction (10 cases), discordant anomalies (17 cases) and multifetal pregnancy reduction in triplets or quadruplets with a MC pair (nine cases). Twenty‐six (41.3%) of these procedures were performed before and 37 (58.7%) after 16 weeks. Potential factors that could affect the risk of loss of the cotwin, including gestational age at RFA, order of multiple pregnancy, amnionicity, indication for RFA and number of ablation cycles, were assessed first by univariate analysis and then by multivariate analysis. Results There were 17 (27.0%) cotwin losses. Ablation cycles numbering four or more was the only factor among those investigated to be associated with loss of the cotwin after RFA (P = 0.035; odds ratio, 5.21), while the indication for RFA, order of multiple pregnancy, amnionicity and gestational age at RFA had no effect. Comparing RFA performed at