Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Pasadena, CA, USA.
Childbirth Research Associates, North Hollywood, CA, USA.
Prenat Diagn. 2018 Jan;38(2):110-116. doi: 10.1002/pd.5196. Epub 2018 Jan 9.
To compare outcomes between 2 umbilical cord occlusion (UCO) methods: radiofrequency ablation (RFA) versus fetoscopic-guided laser photocoagulation.
Retrospective study of all monochorionic diamniotic multiple gestations that underwent UCO with RFA (preferred after 2014) or laser (preferred before 2014). In bivariate analysis, patients treated with RFA were compared with laser. Risk factors for intrauterine fetal demise (IUFD) and 30-day survival of the co-twin were identified, and multiple logistic models were fitted to examine whether the UCO method was associated with these outcomes.
Of 60 UCO cases, 18 (30%) underwent RFA and 42 (70%) underwent laser surgery. The RFA method was associated with co-twin IUFD after surgery (6/18 [33.3%] vs 1/42 [2.4%], P = 0.0021). In logistic regression models, patients who underwent RFA were more likely than patients who underwent laser to have an IUFD of the co-twin (OR 13.2, 1.23-142.62, P = 0.0331). These patients were also less likely to have 30-day survival of the co-twin, although this was not statistically significant (OR 0.20, 0.04-1.15, P = 0.0710).
Despite clear technical advantages of RFA compared with laser, we found that RFA appeared to be associated with increased risk of post-procedure fetal demise. Further studies should be conducted to confirm these findings.
比较两种脐带环扎术（UCO）方法的结局：射频消融（RFA）与胎儿镜引导激光光凝。
回顾性分析所有行 UCO 的单绒毛膜双羊膜多胎妊娠病例，这些病例分别接受了 RFA（2014 年后首选）或激光（2014 年前首选）治疗。在双变量分析中，将接受 RFA 治疗的患者与激光治疗的患者进行比较。确定了导致宫内胎儿死亡（IUFD）和存活的对胎 30 天的风险因素，并建立多变量逻辑模型，以检查 UCO 方法是否与这些结局相关。
在 60 例 UCO 病例中，18 例（30%）接受了 RFA，42 例（70%）接受了激光手术。RFA 方法与术后对胎 IUFD 相关（6/18 [33.3%] vs 1/42 [2.4%]，P=0.0021）。在逻辑回归模型中，与接受激光治疗的患者相比，接受 RFA 治疗的患者更有可能发生对胎 IUFD（OR 13.2，1.23-142.62，P=0.0331）。尽管这没有统计学意义，但这些患者的对胎存活 30 天的可能性也较小（OR 0.20，0.04-1.15，P=0.0710）。
尽管 RFA 与激光相比具有明显的技术优势，但我们发现 RFA 似乎与术后胎儿死亡风险增加相关。应进行进一步的研究来证实这些发现。
