单绒毛膜性妊娠行射频消融术后的围产儿及手术相关结局。
Perinatal- and procedure-related outcomes following radiofrequency ablation in monochorionic pregnancy.
机构信息
Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England, United Kingdom; Institute for Reproductive and Developmental Biology, Imperial College London, London, England, United Kingdom; Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England, United Kingdom.
出版信息
Am J Obstet Gynecol. 2014 May;210(5):454.e1-6. doi: 10.1016/j.ajog.2013.12.009. Epub 2013 Dec 4.
OBJECTIVE
We sought to assess the efficacy, complication rates, and outcomes for complex monochorionic pregnancies undergoing selective fetal reduction using radiofrequency ablation (RFA).
STUDY DESIGN
In this prospective observational study, 100 consecutive cases of selective fetal reduction using RFA were analyzed. All cases were managed at the Centre for Fetal Care at Queen Charlotte's and Chelsea Hospital in London. Indications for offering RFA, details of the procedure, and pregnancy outcomes were collected and analyzed.
RESULTS
The main indications for RFA were discordant fetal anomaly and twin-twin transfusion syndrome. Overall live birth rate was 78% and the median gestation at delivery was 35.15 weeks. Delivery <32 weeks' gestation occurred in 17.9% of cases. Postprocedure abnormal antenatal magnetic resonance imaging occurred in 3% of cases. There was no statistical difference in outcomes with regard to gestation when the procedure was performed or the indication for the RFA.
CONCLUSION
RFA appears to be a reasonable option for selective fetal reduction in complex monochorionic pregnancies with an overall survival rate of 78%.
目的
我们旨在评估使用射频消融术（RFA）进行复杂单绒毛膜性妊娠选择性胎儿减灭术的疗效、并发症发生率和结局。
研究设计
在这项前瞻性观察性研究中，分析了 100 例连续使用 RFA 进行的选择性胎儿减灭术病例。所有病例均在伦敦夏洛特皇后和切尔西医院的胎儿护理中心进行管理。收集并分析了提供 RFA 的适应证、手术细节和妊娠结局。
结果
RFA 的主要适应证为胎儿畸形不一致和双胎输血综合征。总体活产率为 78%，分娩时的中位孕龄为 35.15 周。<32 周分娩的发生率为 17.9%。3%的病例在术后出现异常的产前磁共振成像。手术时的孕龄或 RFA 的适应证与结局之间无统计学差异。
结论
对于复杂的单绒毛膜性妊娠，RFA 似乎是一种合理的选择性胎儿减灭术选择，总存活率为 78%。
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