Radiofrequency ablation for selective reduction in complex monochorionic multiple pregnancies: A case series.

Area of Science:

• Maternal-Fetal Medicine
• Minimally Invasive Surgery
• Reproductive Genetics

Background:

• Complex monochorionic multiple pregnancies pose significant risks to fetal well-being.
• Selective fetal reduction is a critical intervention for improving outcomes in these high-risk pregnancies.
• Radiofrequency ablation (RFA) offers a minimally invasive approach for fetal reduction.

Purpose of the Study:

• To evaluate the safety and efficacy of radiofrequency ablation (RFA) for selective fetal reduction.
• To assess pregnancy outcomes and fetal survival rates following RFA in complex monochorionic pregnancies.
• To investigate the neurodevelopmental outcomes of surviving infants.

Main Methods:

• Prospective data collection of RFA procedures for selective fetal reduction from July 2011 to January 2015.
• Analysis of indications, procedural details, fetal demise causes, and pregnancy outcomes.
• Utilized sonography and MRI for fetal brain damage assessment and Gesell Development Schedule for neurodevelopmental follow-up.

Main Results:

• 22 twin and 11 triplet cases underwent RFA, all with single-puncture procedures.
• No maternal complications were observed; preterm premature rupture of membranes (PPROM) rate before 32 weeks was 9%.
• Fetal survival rates were 77% for twins and 91% for triplets, with an overall survival rate of 84%. No neurodevelopmental abnormalities were found in survivors.

Conclusions:

• Radiofrequency ablation (RFA) is an effective and safe minimally invasive option for selective fetal reduction in complex monochorionic multiple pregnancies.
• The procedure is associated with high fetal survival rates and favorable neurodevelopmental outcomes.
• RFA represents a valuable therapeutic option for managing high-risk multiple gestations.