| ObjectiveDiscuss the safety and effectiveness of radiofrequency ablation(RFA)for selective reduction in treating complicated monochorionic multiple pregnancies,analyze factors that affecting perinatal outcomes.MethodsThis is a retrospective case series of selective reduction by RFA in Provincial Hospital Affiliated to Shandong University from July 22,2011 to March 16,2017.Age,gravidities and pregnancies,conception mode,indication of reduction,gestational age at surgery,times of puncture and cycle in operation,complications of mother and fetus,gestational age at delivery,mode of delivery,birth weight,neonatal development after birth are collected and analyzed.Live birth rate is defined as the number of the patientswhose remaining twin delivered lively divided by the number of all patients.Factors affecting the perinatal outcomes are also analyzed.Chi-square test and Fisher's exact test are used to analyze the difference of sample rates among groups,and Kruskal-Wallis H rank test is used to analyze the difference of measurement data among groups which do not meet the conditions of variance analysis.ResultsDuring July 22,2011 to March 16,2017,71 cases received RFA procedure,including:20 cases of reducing fetal numbers in multiple pregnancies(28.2%)(DCTA,MCTA,MCQA),21 cases of discordant for fetal abnormalities(29.6%),20 cases of twin-twin transfusion syndrome(28.1%),7 cases of severe selective intrauterine growth restriction(9.9%),3 cases of twin reversed arterial perfusion sequence(4.2%).The mean gestational age for the procedure is 20.41±3.5 weeks(14.7?27.7week),the successful rate of puncturing is 100%.57 cases in which the umbilical cord blood flow is completely occluded after 1time of cycle,11 cases after 2 times of cycle,and 3 cases after 3 times of cycle.In all 71 patients,12 patients experience abortion,including 9 cases of preterm premature rupture of membrane before 28th week(7 cases occur PPROM in 2 weeks after operation),1 case experience abortion because of high fever and frequent contractions,2 cases experience abortion because of the contractions that are difficult to suppress.5 patients suffer remaining fetal demise.17 patients lose their remaining fetus in all 71 cases.54 patients have their remaining fetus live birth,live birth rate is 76.1%,the mean gestational age at delivery is 36.6±2.9 week(29.1?41.1 week),the mean birth weight is 2633±601 g(1250?3750g),premature birth rate before 34 week is 20.4%(11/54),premature birth rate before 37 week is 40.7%(22/54).Not any retinopathy,intracerebral hemorrhage,neonatal necrotizing enterocolitis,neurologic sequelae of the remaining fetus is found after birth during observational period.There are no significant differences identified in the live birth rate,the mean gestational age at birth,the mean birth weight,the rate of abortion,the rate of fetal demise,the premature birth rate before 37 week among five groups with different surgical indications for RFA,all P>0.05;while the difference in the premature birth rate before 34 week is significant P<0.05,the premature birth rate before 34 week in reducing fetal numbers of multipal pregnancies group,TTTS group,and the TRAP group is clearly higher than the discordant for fetal abnormalities group and the sIUGR group.There is no relationship between perinatal outcomes and the gestational age at surgery.There are no significant differences identified in the live birth rate,the mean gestational age at birth,the mean birth weight,the premature birth rate before 34 week,the premature birth rate before 37 week among 2 groups with different times of cycle in surgery all P>0.05;while the difference in the rate of fetal demise is significant P<0.05,the rate of fetal demise increase with the addition of cycle times.ConclusionRadiofrequency ablation for selective reduction is a safe and effective way in treating complicated monochorionic multiple pregnancies.Surgical indications affect the premature birth rate before 34 weeks of remaining fetuses.Times of cycle affect the rate of fetal demise. |
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