VP22.11: Outcomes of radiofrequency ablation for selective fetal reduction in complicated monochorionic pregnancies performed before or after 16 gestational weeks

Abstract

rising from 3.8 g/dL to 12.1 g/dL). After 2 weeks, there was hydrops resolution and a reduction in MCA-PSV discordance. MR performed 3 weeks after IUT showed periventricular leukomalacia (PVL) in the DT, which died at 32 weeks with no consequences for the RT. Case 2: A MC complicated by sIUGR developed TAPS at 23 weeks with reversed-end diastolic flow in the umbilical artery of the DT (stage 3). US revealed cortical hyperecogenicity in the DT. Laser surgery was chosen with resolution of TAPS within 48 hours. At 30 weeks, MR revealed severe bilateral PVL and the couple opted for selective feticide. The RT was born at 34 weeks with a good outcome. Fetal anemia is known to increase the risk of brain injury, but it has been described only in single survivors where it follows acute hypovolemia: in such cases, it is still debatable whether a rescue transfusion can play a protective role. Here, the resolution of the anemia in the DT did not prevent the onset of brain injury: the evidence of brain edema needs to be carefully assessed before deciding the treatment option. VP22.10 Incidence of TAPS by ultrasound criteria after fetoscopic laser photocoagulation for Twin-twin transfusion syndrome

A cohort study of the perinatal outcome of radiofrequency ablation in complicated monochorionic multiple pregnancies based on a different needle insert angle

“…There were no significant differences in the pregnancy outcomes between the two groups, including the rates of postprocedural complications, termination of pregnancy after RFA, preterm birth, and live birth. In our study, the overall live birth rate was 73.5%, which is similar to the live birth rate reported by previous 3,9,11 studies. The mean gestational age at delivery was 31.0 AE 7.5 weeks in the abdominal needle insertion group and 32.2 AE 5.5 weeks in the dorsal needle insertion group, which are earlier than those in previous studies.…”

“…A previous study reported that gestational age at delivery was earlier if RFA was performed after 16 weeks. 9 Additionally, Cox regression analysis in this study showed that gestational age at RFA was at independent risk factor of the duration of pregnancy after RFA.…”

“…A previous study reported that gestational age at delivery was earlier if RFA was performed after 16 weeks. 9 Additionally, Cox regression analysis in this study showed that gestational age at RFA was at independent risk factor of the duration of pregnancy after RFA. With regard to application of RFA for treating complicated MC multiple pregnancies, previous studies examined the efficacy and pregnancy outcome on the basis of indications and gestational age at this procedure.…”

“…The mean gestational age at delivery was 31.0 AE 7.5 weeks in the abdominal needle insertion group and 32.2 AE 5.5 weeks in the dorsal needle insertion group, which are earlier than those in previous studies. 3,4,9 The reason for this finding may be because the mean gestational weeks at RFA was later than 16 weeks reported in these previous studies (mean gestational age at RFA: 20.3 AE 3.2 and 20.8 AE 3.4 weeks, respectively). A previous study reported that gestational age at delivery was earlier if RFA was performed after 16 weeks.…”

“…The impedance feedback system of the ablation generator automatically turned off the power output when the impedance of the target tissue became too high after it was completely desiccated (impedance “roll-off”). 9 If there was no impedance roll-off, ablation was maintained for 2 to 3 minutes after reaching a target temperature of 100°C. The procedure was repeated for an additional one or two cycles using the same heating algorithm, until cessation of cord blood flow was confirmed using color and power Doppler velocimetry (EPIQ5; Philips Ultrasound, Bothell, WA, USA).…”