BACKGROUND
Selective cord occlusion is an option in complicated monochorionic multiple gestations
with the goal of reducing the pregnancy by one fetus and to optimize the outcomes
for the remaining fetus(es).
OBJECTIVE
This study aimed to determine the rate and associated risk factors of dual demise
in complex monochorionic pregnancies after selective cord occlusion via radiofrequency
ablation.
STUDY DESIGN
This was a single-center analysis of a prospective registry cohort of complex monochorionic
pregnancies managed with selective cord occlusion via radiofrequency ablation between
2014 and 2021. A total of 167 pregnancies met the inclusion criteria and were evaluated
on the basis of the intended outcome of dual demise vs singleton survival. Risk factors
were compared between the 2 groups. The Mann–Whitney U test was used for continuous variables and the Fisher exact test was used for categorical
variables.
RESULTS
The incidence of postprocedure dual demise within the first week after performing
radiofrequency ablation was 10.8% (18/167). The risk was higher in pregnancies undergoing
radiofrequency ablation for discordant anomaly, and this subcategory constituted 38.9%
of pregnancies in the dual demise subgroup (P=.02). Lower intertwin estimated fetal weight discordance (P=.01) was associated with dual demise. Perioperative variables including gestational
age at procedure, placental cord insertion distance, operative time, and radiofrequency
ablation time were similar in those with and without dual demise.
CONCLUSION
Our results show that selective cord occlusion via radiofrequency ablation is a safe
and reasonable option in complicated monochorionic pregnancies, with low rates of
dual demise within the first week after the procedure.
Key words
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References
- Diagnosis and management of complicated monochorionic twins.Clin Obstet Gynecol. 2015; 58: 632-642
- Monochorionic diamniotic twins: complications and management options.Curr Opin Obstet Gynecol. 2003; 15: 177-194
- Uncommon complications of monochorionic twin pregnancies: twin anaemia-polycythaemia sequence.Australas J Ultrasound Med. 2016; 19: 56-63
- Congenital anomalies in twins: a register-based study.Hum Reprod. 2008; 23: 1306-1311
- Prevalence of congenital heart defects in monochorionic/diamniotic twin gestations: a systematic literature review.J Ultrasound Med. 2007; 26: 1491-1498
- Co-twin prognosis after single fetal death: a systematic review and meta-analysis.Obstet Gynecol. 2011; 118: 928-940
- Risk factors for fetal death after radiofrequency ablation for complicated monochorionic twin pregnancies.Prenat Diagn. 2018; 38: 499-503
- Perinatal outcomes after selective feticide via umbilical cord occlusion in complicated monochorionic pregnancies: a systematic review and meta-analysis.Prenat Diagn. 2022; 42: 37-48
- Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies.Ultrasound Obstet Gynecol. 2012; 40: 319-324
- Risk factors for co-twin fetal demise following radiofrequency ablation in multifetal monochorionic gestations.Fetal Diagn Ther. 2020; 47: 1-7
- Influence of indications on perinatal outcomes after radio frequency ablation in complicated monochorionic pregnancies: a retrospective cohort study.BMC Pregnancy Childbirth. 2021; 21: 41
- Umbilical cord occlusion for selective feticide in complicated monochorionic twins: a systematic review of literature.Am J Obstet Gynecol. 2009; 200: 123-129
- Selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies.Semin Fetal Neonatal Med. 2017; 22: 376-382
- Staging of twin-twin transfusion syndrome.J Perinatol. 1999; 19: 550-555
- The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease.Am J Obstet Gynecol. 2007; 197 (392.e1–8)
Slaghekke F, Kist WJ, Oepkes D, et al. Twin Anemia-Polycythemia Sequence: Diagnostic Criteria, Classification, Perinatal Management and Outcome. Fetal Diagn Ther. 2010;27:181–190.
- Short-term flow changes in monochorionic survivor twins after ultrasound-guided umbilical cord occlusion.Fetal Diagn Ther. 2020; 47: 45-53
- Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure.Ultrasound Obstet Gynecol. 2019; 53: 47-54
Article info
Publication history
Published online: December 17, 2022
Accepted:
December 15,
2022
Received:
December 6,
2022
Footnotes
Cite this article as: Soni S, Gebb JS, Moldenhauer JS, et al. Predictors of dual demise within the first week after selective cord occlusion via radiofrequency ablation for complex monochorionic pregnancies. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
The authors report no conflict of interest.
This study was presented at the 42nd annual meeting of the Society for Maternal-Fetal Medicine, held virtually, January 31–February 5, 2022.
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