Perinatal Outcomes following Radiofrequency Ablation in Complicated Monochorionic Multiple Pregnancies

Background Radiofrequency ablation (RFA) is considered as an optional treatment method in complicated monochorionic (MC) twin pregnancies. The purpose of this study is to investigate the main factors of fetal death after such treatment procedure. The study also compares the perinatal outcomes among various groups of indication and gestational age (GA) at procedure. Materials and Methods: This prospective cohort study considers ۱۹۵ cases of MC multiple pregnancies including one twin with twin-twin transfusion syndrome, selective intrauterine growth restriction ,sever anomaly and twin reversed arterial perfusion sequence(TRAP) which underwent selected reduction using RFA from ۲۰۱۶ to ۲۰۱۸ at Yas Hospital, Tehran, Iran. The GA at RFA categorized as ۱۶- ۱۹+۶ wks., ۲۰-۲۳+۶ wks., and ۲۴-۲۸ wks. The analysis of risk factors of fetal death after RFA is based on multivariable logistic regression model. Results: The result of analysis reveals that the rate of co-twin anemia after RFA in anomaly indication was higher than the other indications significantly (p=۰.۰۳۸) while according to GA categories, it is significantly lower in ۲۰-۲۳+۶ weeks. (p=۰.۰۱۶). Three independent significant factors contributing in fetal death after RFA were co-twin anemia after RFA, TRAP and anomaly indications of RFA and GA at RFA, respectively. Conclusion The co-twin anemia after RFA was found the most contributing factor of fetal death. As the results showed that the rate of co-twin anemia after RFA is significantly low in ۲۰-۲۳+۶ weeks of GA, such GA is suggested for RFA procedure to reduce the fetal death.

Keywords:

death , Radiofrequency Ablation , Monochorionic multiple pregnancies , Co-twin anemia