Dadhwal Vatsla, Sharma Aparna K., Deka Dipika, Chawla Latika, Agarwal Nutan
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
J Turk Ger Gynecol Assoc. 2019 May 28;20(2):79-83. doi: 10.4274/jtgga.galenos.2018.2018.0052. Epub 2018 Oct 9.
In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cord coagulation with lasers are the methods proposed for selective fetal reduction. This study brings forth preliminary data of selective fetal reduction procedures at a tertiary care center in India.
This was a prospective observational study of 31 patients with complicated mono-chorionic twin pregnancies. Methods used were ILA, RFA and BPCC. Outcome measures included overall co-twin survival after selective feticide, survival rates with each method, miscarriage (defined as all fetal loss before 24 weeks), early fetal death (<24 hours after procedure) and late fetal death (>24 hours after the procedure) of co-twin.
Technical success was achieved in 30/31 (96.8%) of pregnancies. Over all take home baby rate was 63.3%. Live birth rates were 50%, 71.4% and 75% with ILA, RFA and BPCC respectively.
Data from initial cases of selective fetal reduction in complicated mono-chorionic twins suggests that these procedures are feasible but are associated with high adverse perinatal outcome.
在复杂的单绒毛膜双胎妊娠中，双极脐带凝固术（BPCC）、射频消融术（RFA）、脐带间质激光消融术（ILA）以及胎儿镜引导下的激光脐带凝固术等血管闭塞技术是被提议用于选择性减胎的方法。本研究展示了印度一家三级医疗中心选择性减胎手术的初步数据。
这是一项对31例复杂单绒毛膜双胎妊娠患者的前瞻性观察研究。使用的方法包括ILA、RFA和BPCC。观察指标包括选择性杀胎后双胎的总体存活情况、每种方法的存活率、流产（定义为妊娠24周前的所有胎儿丢失）、双胎的早期胎儿死亡（手术后<24小时）和晚期胎儿死亡（手术后>24小时）。
31例妊娠中有30例（96.8%）手术成功。总体带回家婴儿率为63.3%。ILA、RFA和BPCC的活产率分别为50%、71.4%和75%。
复杂单绒毛膜双胎选择性减胎初始病例的数据表明，这些手术是可行的，但与围产期不良结局发生率高相关。
