Perinatal- and procedure-related outcomes following radiofrequency ablation in monochorionic pregnancy

Kumar, Sailesh; Paramasivam, G.; Zhang, Eko; Jones, B.; Noori, Muna; Prior, Tomas; Vasudeva, Akhila; Wimalasundera, R.

doi:10.1016/j.ajog.2013.12.009

Cited by 55 publications

(87 citation statements)

References 11 publications

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“…An overview of survival rates of TRAP sequence treated with RFA is presented in table 3[8,16,17,18,19,20,21,22,23]. We excluded the reports that included the cases also reported in other references.…”

Section: Discussionmentioning

confidence: 99%

“…If an acardiac twin is near a pump twin or a placenta, or an acardiac twin is relatively small, we should take care to avoid thermal injury during the procedure. In fact, 2 cases of presumed thermal injury to a pump twin that may have occurred as a result of one of the tines coming into contact with the pump twin were reported, causing thermal injury and subsequent necrosis of the lower limb [20]. An internally cooled electrode can be readily inserted and is easy to manipulate.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, an internally cooled electrode can maintain a low electrode temperature, avoid the increase in tissue impedance even with high power and achieve an increase in necrosis volume [26]. At present, in most of the reports regarding RFA for TRAP sequence, an expandable needle electrode was used [8,9,10,11,12,13,14,15,16,17,18,19,20,21] but only a few case reports describe an internally cooled electrode [22,23]. Therefore, it remains unknown which electrode is more suitable for the treatment of TRAP sequence.…”

Section: Introductionmentioning

confidence: 99%

“…The natural history for TRAP sequence progresses to >50% mortality of the pump twin because of high-output heart failure or premature delivery caused by polyhydramnios [1]. Various intrauterine interventions focused on disruption of perfusion into the acardiac twin have been introduced to improve the outcome of the pump twin: cord coagulation [2,3], umbilical cord ligation [4], photocoagulation of the anastomoses [5], interstitial laser therapy [6,7,8] and radiofrequency ablation (RFA) [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Wagata

Murakoshi²,

Ishii³

et al. 2016

Fetal Diagn Ther

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Objective: The study aims to evaluate the efficacy of radiofrequency ablation (RFA) with an internally cooled electrode for twin reversed arterial perfusion (TRAP) sequence. Methods: From April 2008 through December 2014, we retrospectively reviewed all patients who underwent RFA with an internally cooled electrode for TRAP sequence at 3 tertiary referral centers in Japan. Results: Twenty-five monochorionic diamniotic twin pregnancies underwent RFA with an internally cooled electrode for TRAP sequence at 16-27 weeks of gestation. In all cases, umbilical cord blood flow cessation in the acardiac twin was confirmed by ultrasonography with color Doppler. There were 2 cases of procedure-related complications: 1 case of unintentional septostomy and 1 case of anemia in a pump twin. Fetal demise of the pump twin occurred in 3 (12%) cases. Twenty-two (88%) of 25 pump twins were delivered alive. The median gestational age at delivery was 36 + ³ weeks (range 25 + ²-40 + ⁵ weeks). There were 14 cases (64%) of premature deliveries before 37 weeks and 5 (23%) before 32 weeks. Conclusion: RFA with an internally cooled electrode is a feasible and effective procedure for the treatment of TRAP sequence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Wagata

Murakoshi²,

Ishii³

et al. 2016

Fetal Diagn Ther

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show abstract

“…RFA has potential benefits over other modalities because the diameter of the shaft is relatively small, making the procedure minimally invasive and applicable in early gestations as well. Consequently, RFA is characterized by high survival rates for the co-twin and low rates of preterm premature rupture of the membranes [1-3]. Aside from the incidence of preterm premature rupture of the membranes, no studies with respect to other procedure-related complications after RFA have been published to date.…”

Section: Discussionmentioning

confidence: 99%

Fatal Umbilical Cord Strangulation in the Remaining Co-Twin after Selective Foeticide with Radiofrequency Ablation for Twin-Twin Transfusion Syndrome

et al. 2018

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We report a case of a monochorionic diamniotic twin diagnosed with twin-twin transfusion syndrome (TTTS; stage 3) with co-existing severe cerebral damage in the donor twin at 18 + 4 weeks’ gestation. After counselling, the parents opted for selective foeticide of the donor twin. For the procedure, radiofrequency ablation (RFA) was used. Serial ultrasound examinations at 20 + 1 and 21 + 1 weeks’ gestation showed good recovery of the ex-recipient, after which the patient was sent back to the referring hospital. At 29 + 5 weeks’ gestation, an unexpected foetal death was diagnosed. On macroscopic placental examination, (iatrogenic) monoamnionicity was detected. In addition, the umbilical cord of the recipient was found to be constricted by the macerated umbilical cord of the ex-donor. This case demonstrates that iatrogenic monoamnionicity can be a serious complication of RFA in monochorionic twins complicated by TTTS, with a subsequent risk for cord entanglement leading to a fatal outcome for the remaining co-twin. Although the actual incidence of iatrogenic monoamnionicity after RFA remains unknown, increased attention to the intactness of the inter-twin membrane even weeks after the RFA may be required.

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Perinatal outcome in monochorionic twin pregnancies after selective fetal reduction using radiofrequency ablation

Dadhwal

Sharma

Rana

et al. 2021

Intl J Gynecology & Obste

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Monochorionic (MC) twins are at a higher risk of perinatal morbidity and mortality because of the presence of interconnecting placental vascular anastomoses. It leads to a unique set of complications such as twin-to-twin transfusion syndrome (TTTS), twin reversed arterial perfusion (TRAP), twin anemia polycythemia sequence, and selective fetal growth restriction (sFGR). These complications can lead to the in utero demise of one twin, which can in turn result in hypotension and acute feto-fetal transfusion leading to death or neurologic abnormality in the surviving twin in 12% and 18% of cases, respectively. 1 When delivery is not an option because of a periviable gestation, selective fetal reduction can be offered to optimize perinatal outcome of the healthy

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Perinatal- and procedure-related outcomes following radiofrequency ablation in monochorionic pregnancy

Cited by 55 publications

References 11 publications

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Fatal Umbilical Cord Strangulation in the Remaining Co-Twin after Selective Foeticide with Radiofrequency Ablation for Twin-Twin Transfusion Syndrome

Perinatal outcome in monochorionic twin pregnancies after selective fetal reduction using radiofrequency ablation

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