Shi X M, Rao T Z, Liu Q, Fang L Y, Shi L S, Huang H M, Wu J
Gentic Medical Center, Guangdong Women and Children Hospital, Guangzhou 511400, China.
Zhonghua Fu Chan Ke Za Zhi. 2019 Nov 25;54(11):736-740. doi: 10.3760/cma.j.issn.0529-567x.2019.11.004.
To assess the effectiveness of radiofrequency ablation (RFA) in the treatment of multiple pregnancies. In this retrospective study, 84 cases (total 174 fetuses) of complex monochorionic pregnancies treated with RFA for selective fetal reduction were analyzed. All cases were managed in the Guangdong Women and Children Hospital from January 2015 to January 2018. Indications for offering RFA, details of the procedure and pregnancy outcomes were collected and analyzed. (1)The rate of miscarriage and fetal intrauterine death was 21% (18/84), termination of pregnancy because of fetal malformation or oligohydramnion occurred in 10% (8/84) of cases. Total live birth rate was 69% (58/84) and the gestation age at delivery was (35.0±3.0) weeks. (2) The live birth rate of twin reversed arterial perfusion sequence (TRAPS) was the lowest (6/11), followed by twin to twin transfusion syndrome (TTTS; 66%, 27/41), structural or genetic abnormalities of one fetus in monochorionic twin pregnancy (10/14), triplet pregnancy reduction (4/6) and selective intrauterine growth restriction (sIUGR) (11/12). (3) The live birth rate was 67% (20/30) in stage Ⅲ of TTTS and 7/11 in the stage Ⅳ of TTTS (>0.05). The average gestational age was (33.6±3.0) weeks in stage Ⅲ of TTTS compared with (36.5±2.4) weeks in the stage Ⅳof TTTS (<0.05). RFA appears to be a reliable option for selective fetal reduction in monochorionic multiple pregnancies. The indication of RFA is an influencing factor on its pregnancy outcomes. Type Ⅱand type Ⅲ sIUGR may choose this technique as a priority. Compared with stage Ⅲ of TTTS, the live birth rate and the gestation age at delivery in stage Ⅳ of TTTS, there are no significant differences.
评估射频消融术（RFA）治疗多胎妊娠的有效性。在这项回顾性研究中，分析了84例（共174个胎儿）接受RFA选择性减胎治疗的复杂性单绒毛膜性多胎妊娠病例。所有病例均于2015年1月至2018年1月在广东省妇幼保健院接受治疗。收集并分析了提供RFA的指征、手术细节及妊娠结局。（1）流产和胎儿宫内死亡发生率为21%（18/84），因胎儿畸形或羊水过少而终止妊娠的病例占10%（8/84）。总活产率为69%（58/84），分娩时的孕周为（35.0±3.0）周。（2）双胎反向动脉灌注序列（TRAPS）的活产率最低（6/11），其次是双胎输血综合征（TTTS；66%，27/41）、单绒毛膜双胎妊娠中一个胎儿的结构或基因异常（10/14）、三胎减胎（4/6）和选择性胎儿生长受限（sIUGR）（11/12）。（3）TTTSⅢ期的活产率为67%（20/30），TTTSⅣ期的活产率为7/11（>0.05）。TTTSⅢ期的平均孕周为（33.6±3.0）周，而TTTSⅣ期为（36.5±2.4）周（<0.05）。RFA似乎是单绒毛膜性多胎妊娠选择性减胎的可靠选择。RFA的指征是影响其妊娠结局的一个因素。Ⅱ型和Ⅲ型sIUGR可优先选择该技术。与TTTSⅢ期相比，TTTSⅣ期的活产率和分娩孕周无显著差异。
