Predictors of dual demise within the first week after selective cord occlusion via radiofrequency ablation for complex monochorionic pregnancies

Soni, Shelly; Gebb, Juliana; Moldenhauer, Julie S.; Hwang, Rosa; Teefey, Christina Paidas; Oliver, Edward R.; Khalek, Nahla

doi:10.1016/j.ajogmf.2022.100842

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…In contrast, it takes a relatively long time to completely block the flow of the targeted umbilical cord in a single-step RFA procedure, during which the thrombus formed in the umbilical vein may dislodge with the blood flow into the retained fetus and embolize vital organs, causing fetal death. Additionally, once one MC twin dies, there may be an acute transfusion event through the intertwined placental anastomoses, resulting in hypovolemic shock, neurological injury or even death of the remaining fetus 12,27,28 .…”

Section: Discussionmentioning

confidence: 99%

New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique

Zhang,

Jiao'e,

Chen

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesRadiofrequency ablation (RFA) is the preferred approach for selective reduction in complex monochorionic (MC) multiple pregnancies because of its ease of operation and minimal invasiveness. To optimize the RFA technique and reduce adverse pregnancy outcomes due to the heat‐sink effect of RFA therapy, we used an innovative RFA method in which a needle, an expansion‐type electrode, was expanded incrementally and stepwise. This study assessed the safety profile of this novel multistep incremental expansion (multistep) RFA method, including postoperative, maternal, and fetal complications. This study aimed to evaluate the efficacy of selective fetal reduction using multistep radiofrequency ablation (RFA) in multiple MC pregnancies.MethodsThis single‐center retrospective cohort study included all MC pregnancies treated with RFA between March 2016 and October 2022. The multistep RFA technique involved the use of an expandable needle for gradual dilation during the RFA procedure until the cord blood flow stopped. The traditional single‐step RFA method was fully extended at the start of treatment.ResultsIn this study, 132 MC multiple pregnancies were treated with selective reduction using RFA: 50 with multistep RFA and 82 with single‐step RFA. The overall survival rates were not significantly different between the two groups (81.1% vs. 72.3%, P = 0.186). Similarly, the rates of preterm premature rupture of the membranes within 2 weeks after RFA, procedure‐related complications, spontaneous preterm delivery < 34 weeks, abortion < 28 weeks, gestational age at delivery, birth weight of the live fetus, and pathological cranial ultrasound did not differ between the groups. However, there was a trend toward a prolonged procedure‐to‐delivery interval (median, 109 vs. 99 days, P = 0.377) in multistep RFA compared with single‐step RFA. Moreover, the fetal loss rate within 2 weeks after RFA in the multistep RFA group was significantly lower than that in the single‐step RFA group (10.0% vs. 24.4%, P = 0.041). The ablation time was shorter (5.30 vs. 7.75 min, P < 0.001) and the ablation energy was less (10.2 vs. 18.0 kJ, P < 0.001) in multistep RFA than in single‐step RFA. There were no significant differences in neonatal outcomes.ConclusionsOverall survival rates were similar between the two RFA methods. The multistep RFA technique resulted in significantly less ablation energy and shorter ablation time than single‐step RFA in the selective fetal reduction of MC pregnancy. The multistep RFA technique was associated with a lower risk of fetal loss within 2 weeks after RFA. Additionally, there was a trend toward a prolonged procedure‐to‐delivery interval with the multistep RFA technique.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique

Zhang,

Jiao'e,

Chen

et al. 2024

Ultrasound in Obstet & Gyne

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“…This impacts the survival and live birth rates of fetuses. 15 In cases where the abnormality is lethal and affects the survival of normal cotwins, it is considered best to avoid and prevent risk to normal cotwins. 16 Studies conducted to report outcomes associated with discordant twins have been the least studied, particularly in the Indian population.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Twins Discordant for Major Anomalies

Bhutia,

Kolar,

Kavuri

et al. 2024

Journal of Fetal Medicine

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Objectives This article determines the incidence, management, and outcomes of twins discordant for major structural anomalies. Materials and Methods A retrospective observational study was conducted from 2011 to 2021. Pregnant women discordant for major malformations as confirmed postnatally were included in the study. Demographic and clinical details were collected from medical records. Determining the incidence and profile of twins discordant for major structural anomalies and their management and outcomes were considered as primary objectives that were detailed in dichorionic (DC) and monochorionic (MC) twin pregnancies. Results A total of 83 subjects were included, with an incidence of 1.76% in DC pregnancies and 1.4% in MC pregnancies. Major structural anomalies among DC twins were musculoskeletal (26%), followed by circulatory system anomalies (20.2%), while among MC twins, the majority were found to be central nervous system anomalies (35.7%). Gastrointestinal system anomalies were found the least, with 5.8% in DC anomalous twins, and none were observed in MC anomalous twins. Live birth rate among anomalous twins was found to be 79.71 and 64.29%, and in normal cotwins, it was 92.75 and 85.71% in DC and MC twins, respectively. Surviving anomalous twins underwent postnatal surgery or intervention in 25/69 (36.2%) DC twins, out of which 20 infants were alive and healthy. In the MC anomalous twin group, 3/14 (21.42%) underwent surgical correction; all were alive and well. Postnatally, babies were followed up until 2 years of life. The survival rate for anomalous twins was 47.82% in DC and 35.7% in MC twins. Normal cotwins had overall favorable outcomes, with a survival rate of 89.8 and 85.7% in DC and MC twins, respectively. Conclusion In DC twins discordant for major anomalies, expectant management is a safe option.

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Predictors of dual demise within the first week after selective cord occlusion via radiofrequency ablation for complex monochorionic pregnancies

Cited by 2 publications

References 18 publications

New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique

New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique

Outcome of Twins Discordant for Major Anomalies

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