Radiofrequency ablation for selective reduction in complex multifetal pregnancies: 33 cases report

Results 21 MCDA twins, 1 MCMA twin, 2 MCTA, and 9 DCTA triplets cases chose to receive reduction of one of the monochorionic twins. The MCDA group include 6 TTTS patients (4 cases of stage III and 2 cases of stage IV), 2 cases of TRAP, 10 fetal malformation and 4 cases of sIUGR. The median gestational age at procedure was 27+1(14+3 to 27+2). All surgery succeeded with one puncture. Four cases aborted (one retained fetus of MCMA died 10 hours after procedure; two MCDA cases experienced PROM of vaginal bleeding about three weeks after the procedure, and 1 case of a cephalic malformation aborted 4+4 weeks after procedure at 25w ). 1 case of TRAP received rivanol abortion 2+3 weeks after the surgery at 25 weeks due to the exacerbation of asthma. 2 cases of DATA choose to ablate one of the MD twins experienced intrauterine demise of the co-twin 24 hours later and at 25w(9 weeks later) respectively, and each finally got one live birth at 37w and 37+6w. 5 cases were still in pregnancy (1 MCDA sIUGR 30w, 1 fetal limb deformaties 28w, 1 fetal an encephalic 28w, 1 DCTA 118w, 1 DATA 35w). The overall live birth rate was 82. 14% (23/28) at an average gestational age of 36+6 weeks(from 32 to 39+3 weeks), Sonography inspection for the reserved fetus, placenta, and middle cerebral artery peak systolic velocity, MRI with the fetal brain after the intervention, and the follow-up investigations about the development of the survivors indicated no abnormality.