Comparison of umbilical cord occlusion methods: Radiofrequency ablation versus laser photocoagulation

Abdel-Sattar, Mira; Chon, Andrew H.; Llanes, Arlyn; Korst, Lisa M.; Ouzounian, Joseph G.; Chmait, Ramen H.

doi:10.1002/pd.5196

Cited by 19 publications

(25 citation statements)

References 26 publications

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“…However, while Yinon et al found similar rates of preterm delivery following RFA and BC, 12 we found a significantly higher rate of preterm delivery following both BC and laser, compared to RFA, and fewer adverse perinatal outcomes following RFA. Unlike one meta‐analysis that reported higher rates of PPROM with BC, 21 we found no such difference in PPROM rates with any method, in accordance with other studies 11,12 . Our results also differ from a recent study comparing RFA with laser, which found a similar GA at delivery following both techniques, but worse outcomes following RFA, specifically a higher rate of co‐twin demise 11 .…”

Section: Discussionsupporting

confidence: 77%

Selective fetal reduction in complicated monochorionic twin pregnancies: A comparison of techniques

et al. 2020

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Objective To compare perinatal outcomes associated with three methods of selective reduction in complicated monochorionic (MC) twin pregnancies: bipolar cord coagulation (BC), fetoscopic or ultrasound guided laser cord occlusion and radiofrequency ablation (RFA). Methods Retrospective cohort study of complicated MC twin pregnancies undergoing selective fetal reduction at a tertiary fetal center over a 20‐year period. Obstetric and perinatal outcomes were compared. Results 105 procedures met inclusion criteria: 74 RFAs, 17 lasers and 14 BCs. Procedure duration was significantly shorter for RFA (27.4 ± 15.8 minutes) compared to BC (91.7 ± 38.7 minutes) and laser (83.4 ± 40.4 minutes), P < .0001). The incidence of preterm prelabor rupture of membranes (PPROM) and co‐twin demise did not differ between groups, however preterm delivery <34 weeks occurred less frequently following RFA (29.7%), compared to laser (64.7%) or BC (42.9%) (P = .02); delivery <37 weeks was also less frequent following RFA (45.9%), compared to laser (76.5%) or BC (78.6%)(P = .01). The difference in preterm birth<34 weeks between RFA and laser was maintained after adjusting for cord occlusion indication and amnionicity (OR 3.96, 95% CI 1.27‐12.31). Conclusions In our experience, RFA procedures were simpler, faster and associated with a lower risk of preterm delivery <34 and <37 weeks, compared to laser or BC.

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Section: Discussionsupporting

confidence: 77%

Selective fetal reduction in complicated monochorionic twin pregnancies: A comparison of techniques

et al. 2020

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“…Criteria for using RFA at our center have been previously described [22, 23]. Routine indications for RFA primarily include TRAP sequence and obligate lethal discordant anomalies.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Co-Twin Fetal Demise following Radiofrequency Ablation in Multifetal Monochorionic Gestations

et al. 2020

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Background: Umbilical cord occlusion via radiofrequency ablation (RFA) is utilized to maximize outcomes of the cotwin in complicated multifetal monochorionic (MC) gestations. However, post-procedure co-twin fetal demise is of concern. Objective: The aim of this study was to determine risk factors for co-twin fetal demise following RFA. Methods: This is a retrospective study of MC multiples that underwent RFA. Indications for RFA included twin reversed arterial perfusion (TRAP) sequence, selective fetal growth restriction (sFGR) type II, discordant lethal anomalies, and twin-twin transfusion syndrome (TTTS) with proximate placental cord insertion sites. The primary outcome was co-twin fetal demise. Bivariate analyses and multiple logistic regression modeling of identified risk factors were conducted. Results: Of 36 patients studied, surgical indications were: TRAP (n = 15, 41.7%), sFGR (n = 10, 27.8%), discordant anomalies (n = 9, 25.0%), and TTTS (n = 2, 5.6%). Nine patients (25.0%) experienced a co-twin fetal demise. In multiple logistic regression analysis, fetal growth restriction (FGR) of one co-twin was associated with increased risk of co-twin fetal demise (OR = 10.85, 95% CI 1.03-114.48, p = 0.0474) and a preoperative diagnosis of TRAP was protective against fetal demise (OR = 0.06, 95% CI 0.00-0.84, p = 0.0368). Conclusion: Co-twin FGR was associated with an increased risk of post-RFA demise. When compared to other indications, patients with TRAP sequence were less likely to have a co-twin demise.

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“…RFA, using a 17-gauge needle to ablate tissues within 2 cm diameter, is relatively simple and effective, obtaining a lower incidence of preterm premature rupture of membranes (PPROM) and preterm delivery [5,8,13]. Other advantages that make RFA the preferred technique involve situations where there is difficulty in terms of access to other surgical treatments, including oligohydramnios of the target twin, proximity of twin cord insertion sites, anterior placenta or earlier gestational age [14].…”

Section: Introductionmentioning

confidence: 99%

“…The primary indications for RFA are TRAPs and other lethal foetal anomalies [14]. After RFA, the overall survival rate of the co-twin in TRAPs is determined to be at 75.0-92% [8][9][10][15][16][17][18][19], but it varies in other anomalies, ranging 33-92.3% [8,13,15].…”

Section: Introductionmentioning

confidence: 99%

Influence of indications on perinatal outcomes after radio frequency ablation in complicated monochorionic pregnancies: a retrospective cohort study

Wang

Zhou

Wang

et al. 2021

BMC Pregnancy Childbirth

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Background Radiofrequency ablation (RFA) is recommended to prevent potential neurological injury or intrauterine foetal death (IUFD) of the co-twin(s) in complicated monochorionic (MC) pregnancies. However, the impacts of various indications on the pregnancy outcome following RFA remain unclear. This study aimed to determine how the indications influence the perinatal outcomes in complicated MC pregnancies undergoing radiofrequency ablation. Methods This was a retrospective cohort study performed in a single centre. All consecutive MC pregnancies treated with RFA between July 2011 and July 2019 were included. The adverse perinatal outcomes and the survival rate were analysed based on various indications. The continuous variables with and without normal distribution were compared between the groups using Student’s t-test and Mann–Whitney U test, respectively, and for categorical variables, Chi-square and Fisher’s exact tests were used. P < 0.05 indicated a significant difference. Results We performed 272 RFA procedures in 268 complicated MC pregnancies, including 60 selective intrauterine growth restriction (sIUGR), 64 twin–twin transfusion syndrome (TTTS), 12 twin reversed arterial perfusion sequence (TRAPs), 66 foetal anomaly and 66 elective foetal reduction (EFR) cases. The overall survival rate of the co-twin was 201/272 (73.9%). The overall technical successful rate was determined at 201/263 (76.7%). The IUFD rate in the co-twin was 20/272 (7.4%). The TTTS group had recorded the lowest survival rate (37/64, 57. 8%), and the survival rate was significantly correlated with Quintero stages (P = 0.029). Moreover, the sIUGR III subgroup had a lower survival rate compared with sIUGR II (55.6%, versus 84.3%). The subgroup of foetal anomaly of gastroschisis or exomphalos had the highest IUFD rate (4/10, 40%), followed by sIUGR III (2/9, 22.2%) and dichorionic triamniotic (DCTA) subgroup (8/46, 17.9%). In EFR group, eight IUFD cases were all coming from the DCTA subgroup and received RFA before 17 weeks. Conclusions The perinatal outcome of RFA was correlated with the indications, with the lowest survival rate in TTTS IV and the highest IUFD incidence in abdominal wall defect followed by sIUGR III. Elective RFA after 17 weeks may prevent IUFD in DCTA pregnancies.

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Comparison of umbilical cord occlusion methods: Radiofrequency ablation versus laser photocoagulation

Abstract: Despite clear technical advantages of RFA compared with laser, we found that RFA appeared to be associated with increased risk of post-procedure fetal demise. Further studies should be conducted to confirm these findings.

Cited by 19 publications

References 26 publications

Selective fetal reduction in complicated monochorionic twin pregnancies: A comparison of techniques

Selective fetal reduction in complicated monochorionic twin pregnancies: A comparison of techniques

Risk Factors for Co-Twin Fetal Demise following Radiofrequency Ablation in Multifetal Monochorionic Gestations

Influence of indications on perinatal outcomes after radio frequency ablation in complicated monochorionic pregnancies: a retrospective cohort study

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