Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Ultrasound Obstet Gynecol. 2021 Aug;58(2):214-220. doi: 10.1002/uog.22160. Epub 2021 Jul 6.
To investigate whether gestational age at intervention (< or ≥ 16 weeks) and other factors affect the risk of loss of the cotwin after selective fetal reduction using radiofrequency ablation (RFA) in monochorionic (MC) pregnancy.
This was a single-center retrospective analysis of 63 consecutive RFA procedures performed at our institution from January 2011 to October 2019 for selective fetal reduction in complicated MC pregnancies. Indications for RFA were twin reversed arterial perfusion sequence (13 cases), twin-to-twin transfusion syndrome (12 cases), twin anemia-polycythemia sequence (two cases), selective fetal growth restriction (10 cases), discordant anomalies (17 cases) and multifetal pregnancy reduction in triplets or quadruplets with a MC pair (nine cases). Twenty-six (41.3%) of these procedures were performed before and 37 (58.7%) after 16 weeks. Potential factors that could affect the risk of loss of the cotwin, including gestational age at RFA, order of multiple pregnancy, amnionicity, indication for RFA and number of ablation cycles, were assessed first by univariate analysis and then by multivariate analysis.
There were 17 (27.0%) cotwin losses. Ablation cycles numbering four or more was the only factor among those investigated to be associated with loss of the cotwin after RFA (P = 0.035; odds ratio, 5.21), while the indication for RFA, order of multiple pregnancy, amnionicity and gestational age at RFA had no effect. Comparing RFA performed at < 16 vs ≥ 16 weeks, there was no difference in the rate of cotwin loss (23.1% vs 29.7%; P = 0.558) or preterm prelabor rupture of the membranes before 34 weeks (7.7% vs 5.4%; P = 0.853), or in the median gestational age at delivery (36.2 vs 37.3 weeks; P = 0.706).
RFA is a promising tool for early selective fetal reduction in MC pregnancy before 16 weeks. Four or more ablation cycles is a major risk factor for cotwin loss. Careful assessment pre- and post-RFA, together with proficient operative skills to minimize the number of ablation cycles, are the mainstay to ensure that this procedure is effective and safe. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
探讨射频消融术（RFA）治疗复杂性单绒毛膜（MC）妊娠选择性胎儿减灭术时，干预时的孕龄（< 16 周或≥16 周）和其他因素对减灭术后双胎丢失风险的影响。
这是一项单中心回顾性分析，纳入了 2011 年 1 月至 2019 年 10 月我院采用 RFA 治疗 MC 妊娠复杂性胎儿减灭术的 63 例连续病例。RFA 的适应证为：双胎反向动脉灌注序列（13 例）、双胎输血综合征（12 例）、双胎贫血-多血症序列（2 例）、选择性胎儿生长受限（10 例）、畸形不一致（17 例）和三胎或四胎 MC 对中多胎妊娠减少（9 例）。其中 26 例（41.3%）在 16 周前进行，37 例（58.7%）在 16 周后进行。首先通过单因素分析评估可能影响双胎丢失风险的因素，包括 RFA 时的孕龄、多胎妊娠的顺序、羊膜性、RFA 的适应证和消融周期数，然后进行多因素分析。
有 17 例（27.0%）发生双胎丢失。在所有研究因素中，消融周期数≥4 是与 RFA 后双胎丢失相关的唯一因素（P=0.035；优势比，5.21），而 RFA 的适应证、多胎妊娠的顺序、羊膜性和 RFA 时的孕龄无影响。与<16 周与≥16 周时的 RFA 相比，双胎丢失率（23.1%与 29.7%；P=0.558）或 34 周前早产胎膜早破（7.7%与 5.4%；P=0.853）或分娩时的中位孕龄（36.2 与 37.3 周；P=0.706）均无差异。
RFA 是 MC 妊娠 16 周前早期选择性胎儿减灭术的一种有前途的方法。≥4 个消融周期是双胎丢失的主要危险因素。RFA 前后的仔细评估以及熟练的手术技能以尽量减少消融周期数，是确保该操作有效和安全的主要方法。
