A cohort study of the perinatal outcome of radiofrequency ablation in complicated monochorionic multiple pregnancies based on a different needle insert angle

Objective To compare the pregnancy outcomes of radiofrequency ablation (RFA) for complicated multiple pregnancies between fetal abdominal and dorsal needle insertion angles. Methods We performed a historical cohort study of patients who underwent selective reduction using RFA through different needle insertion angles from 2015 to 2018 at a local hospital. Dorsal needle insertion cases were consecutively selected and abdominal needle insertion cases were selectively enrolled. The Cox proportional hazards model was constructed to identify predictors of fetal survival time with different needle insertion angles. Results The RFA procedure was performed in 28 women through an abdominal insertion angle and in 28 women through a dorsal insertion angle. There were no significant differences in perinatal outcomes between the two groups. The overall live birth rate after RFA in the two groups was 73.5% and the mean gestation was 31.6 ± 6.5 weeks. The Cox model showed that gestational age at RFA was a predictor of the duration of the period between RFA and delivery. Conclusion RFA conducted through the dorsal insertion angle is technically feasible for selective reduction in complex monochorionic multiple pregnancies. Gestational age at this procedure is an independent risk factor for the duration of pregnancy post-RFA.

Download Full-text

Radiofrequency ablation for selective reduction in complex monochorionic multiple pregnancies: A case series

Taiwanese Journal of Obstetrics and Gynecology ◽

10.1016/j.tjog.2017.10.006 ◽

2017 ◽

Vol 56 (6) ◽

pp. 740-744 ◽

Cited By ~ 6

Author(s):

Hong-Mei Wang ◽

Hong-Yan Li ◽

Xie-Tong Wang ◽

Yan-Yun Wang ◽

Lei Li ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Case Series ◽

Selective Reduction ◽

Multiple Pregnancies

Download Full-text

Induction of Labour in Growth Restricted and Small for Gestational Age Foetuses – A Historical Cohort Study

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-0834-8199 ◽

2019 ◽

Vol 79 (04) ◽

pp. 402-408

Author(s):

Sven Kehl ◽

Christel Weiss ◽

Ulf Dammer ◽

Sebastian Berlit ◽

Thomas Große-Steffen ◽

...

Keyword(s):

Cohort Study ◽

Caesarean Section ◽

Gestational Age ◽

Small For Gestational Age ◽

Caesarean Section Rate ◽

Growth Restriction ◽

Induction Of Labour ◽

Labour Induction ◽

Historical Cohort ◽

Foetal Growth

Abstract Purpose Induction of labour for small-for-gestational-age (SGA) foetus or intrauterine growth restriction (IUGR) is common, but data are limited. The aim of this study was therefore to compare labour induction for SGA/IUGR with cases of normal foetal growth above the 10th percentile. Material and Methods This historical multicentre cohort study included singleton pregnancies at term. Labour induction for SGA/IUGR (IUGR group) was compared with cases of foetal growth above the 10th percentile (control group). Primary outcome measure was caesarean section rate. Results The caesarean section rate was not different between the 2 groups (27.0 vs. 26.2%, p = 0.9154). In the IUGR group, abnormal CTG was more common (30.8 vs. 21.9%, p = 0.0214), and foetal blood analysis was done more often (2.5 vs. 0.5%, p = 0.0261). There were more postpartum transfers to the NICU in the IUGR group (40.0 vs. 12.8%, p < 0.0001), too. Conclusion Induction of labour for foetal growth restriction was not associated with an increased rate of caesarean section.

Download Full-text

Radiofrequency ablation for selective fetal reduction in complicated Monochorionic twins; comparing the outcomes according to the indications

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03656-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fatemeh Rahimi-Sharbaf ◽

Marjan Ghaemi ◽

Ahmed A. Nassr ◽

Alireza A. Shamshirsaz ◽

Mahboobeh Shirazi

Keyword(s):

Radiofrequency Ablation ◽

Gestational Age ◽

Perinatal Outcomes ◽

Selective Reduction ◽

Success Rates ◽

Maternal Complications ◽

Monochorionic Twins ◽

Arterial Perfusion ◽

Fetal Reduction ◽

The Mean

Abstract Background To evaluate the perinatal outcomes in women with complicated monochorionic diamniotic twins who underwent selective reduction using radiofrequency ablation (RFA). Methods This retrospective study included patients with complicated monochorionic diamniotic twins between 16 to 28 weeks who underwent selective reduction using RFA. Results During the study period, 143 women with complicated monochorionic twins underwent RFA including 52 with selective fetal growth restriction (sFGR), 48 with twin to twin transfusion syndrome (TTTS), 33 with major fetal anomalies in one of the twins, and 10 with reversed arterial perfusion sequence (TRAP). The overall survival was 71.3% (102/143). The procedures were technically successful in achieving selective termination in all cases. The mean ± SD of gestational age at the time of the procedure was 21.0 ± 2.3 weeks. The mean ± SD of gestational age at delivery was 34.6 ± 3.3 weeks. The mean ± SD of overall procedure-to-delivery time was 12 ± 1.7 weeks. The pregnancy success rates among sFGR, TRAP, TTTS and anomaly groups were 82.7, 80, 73 and 60.7% respectively. There were no maternal complications. Conclusion Radiofrequency ablation for fetal reduction in complicated monochorionic twin pregnancies appears to be a reasonable option. The pregnancy success rate following RFA selective reduction was highest among sFGR and TRAP groups and lowest in the anomaly group.

Download Full-text

The Association Between History of an Ankle Sprain and Traumatic Meniscal Injury Among Infantry Combat Soldiers in the Israeli Defense Forces: A Historical Cohort Study

Military Medicine ◽

10.1093/milmed/usz393 ◽

2019 ◽

Vol 185 (5-6) ◽

pp. e748-e754

Author(s):

Oren Schwartz ◽

Shir Bulis ◽

Cara H Olsen ◽

Elon Glasberg ◽

Israel Dudkiewicz

Keyword(s):

Cohort Study ◽

Ankle Sprain ◽

Cox Model ◽

Meniscal Injury ◽

Historical Cohort ◽

Leg Injuries ◽

The Past ◽

Ankle Inversion ◽

Historical Cohort Study ◽

Combat Soldiers

Abstract Introduction The high frequency and number of ankle inversion injuries and meniscal injuries in military populations is an area of concern due to the debilitating effects and cumulative consequences of these particular injuries on the soldiers sustaining injury and the consequences on the operational effectiveness of the Israeli Defense Force (IDF). This study examines the possible relationship between ankle inversion injury and potential for subsequent meniscal injury in infantry soldiers in the IDF. Material and Methods All 89,069 infantry combat soldiers (including special units), recruited to the IDF between 2007 and 2017 were included in this study. A historical cohort study was conducted. The cohort was divided into two groups: The exposure group included all participants that had suffered at least one ankle sprain in the past and the unexposed group that included all participants who did not suffer an ankle sprain in the past. A Cox proportional-hazards model (COX) model was used in order to obtain the adjusted to confounders association between exposure and outcome expressed in hazard ratio (HR). Results The crude association between ankle sprain in the past and the development of meniscal injury in this study was 0.87 (Relative risk = 0.87, P = 0.007). After adjusting for unit type, Body Mass Index (BMI), previous fracture of the lower limb, and the use of eyeglasses, using a COX model, the adjusted association between ankle sprain in the past and the development of meniscal injury was 0.8 (HR = 0.8, P = 0.001, confidence interval (95%) 0.74, 0.88). Conclusion The results of this study indicate ankle sprains to be a protective factor for meniscal injury. Our main conclusion from the results of this study is that the assumption that those with previous leg injuries are at a greater risk for further leg injuries is questionable and cannot be generalized. Hence, the association between different types of injuries should be investigated separately.

Download Full-text

Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Fetal Diagnosis and Therapy ◽

10.1159/000355406 ◽

2013 ◽

Vol 34 (4) ◽

pp. 211-216 ◽

Cited By ~ 11

Author(s):

Jing Lu ◽

Yuen Ha Ting ◽

Kwok Ming Law ◽

Tze Kin Lau ◽

Tak Yeung Leung

Keyword(s):

Radiofrequency Ablation ◽

Selective Reduction ◽

Multiple Pregnancies

Download Full-text

Selective termination of the fetus in multiple pregnancies using ultrasound-guided radiofrequency ablation

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04285-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nan Li ◽

Jimei Sun ◽

Jiayan Wang ◽

Wei Jian ◽

Jing Lu ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Gestational Age ◽

Loss Rate ◽

Fetal Loss ◽

Perinatal Outcomes ◽

Multiple Pregnancies ◽

Ultrasound Guided ◽

Arterial Perfusion ◽

Before And After ◽

Gestational Age At Delivery

Abstract Background To evaluate the perinatal outcomes in women with selective termination using ultrasound-guided radiofrequency ablation (RFA). Methods Complicated monochorionic (MC) twin pregnancies and multiple pregnancies with an indication for selective termination by ultrasound-guided coagulation of the umbilical cord with RFA under local anesthesia between July 2013 and Jan 2020 were reviewed. We analyzed the indications, gestational age at the time of the procedure, cycles of RFA, duration of the procedure, and perinatal outcome. Results Three hundred and thirteen patients were treated during this period. Seven of whom were lost of follow-up. The remaining 306 cases, including 266 pairs of monochorionic diamniotic (MCDA) twins (86.93%), two pairs of monoamniotic twins (0.65%), 30 dichorionic triamniotic (DCTA) triplets (1%), and three monochorionic triamniotic (MCTA) triplets (0.98%), were analyzed. Indications included twin-to-twin transfusion syndrome (TTTS) (n = 91), selective fetal growth restriction (sFGR) (n = 83), severe discordant structural malformation (n = 78), multifetal pregnancy reduction (MFPR) (n = 78), twin reverse arterial perfusion sequence (TRAPS) (n = 19), and twin anemia-polycythemia sequence (TAPS) (n = 3). Upon comparison of RFA performed before and after 20 weeks, the co-twin loss rate (20.9% vs. 21.5%), the incidence of preterm premature rupture of membranes (PPROM) within 24 h (1.5% vs. 1.2%), and the median gestational age at delivery [35.93 (28–38) weeks vs. 36 (28.54–38.14) weeks] were similar (p > 0.05). Conclusions RFA is a reasonable option when indicated in multiple pregnancies and complicated monochorionic pregnancies. In our experience, the overall survival rate was 78.76% with RFA in selective feticide, and early treatment increases the likelihood of survival for the remaining fetus because the fetal loss rate is similar before and after 20 weeks.

Download Full-text

Are neonatal outcomes of triplet pregnancies different from those of singletons according to gestational age?

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0558 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Georgios Mitsiakos ◽

Dimitra Gialamprinou ◽

Ilias Chatziioannidis ◽

Abraham Pouliakis ◽

Christos Georgios Kontovazainitis ◽

...

Keyword(s):

Cohort Study ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Primary Outcome ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Multiple Pregnancies ◽

Extreme Prematurity ◽

Significant Difference

ABSTRACT Objectives Multiple pregnancies sustain the high pace of extreme prematurity. Little evidence is available about triplet gestation given the evolution in their management during the last decades. The aim of the study was to compare the neonatal outcomes of triplets with those of matched singletons in a cohort study. Methods An observational retrospective cohort study of triplets and matched singletons born between 2004 and 2017 matched by gestational age was conducted. Additionally, the investigation performed in regard to data from the overall Greek population of interest. The primary outcome was mortality or severe neonatal morbidity based on pregnancy type. Results A total of 237 triplets of 24–36 weeks’ gestation and 482 matched singletons were included. No differences in the primary outcome between triplets and singletons were found. Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. A threshold of 1000 gr for birthweight and 28 weeks’ gestation for gestational age determined survival on triplets [OR: 0.08 (95% CI: 0.02–0.40, p=0.0020) and OR: 0.13 (95% CI: 0.03–0.57, p=0.0020) for gestational age and birthweight respectively]. In Greece stillbirths in triplets was 8 times higher than that of singletons (OR: 8.5, 95% CI: 6.9–10.5). From 3,375 triplets, 94 were stillborn, whereas in singletons, 4,659 out of 1,388,273. In our center 5 times more triplets than the expected average in Greece were delivered with no significant difference in stillbirths’ rates. Conclusions No significant differences were identified in mortality or major neonatal morbidities between triplets and matched singletons highlighting the significance of prematurity and birthweight for these outcomes.

Download Full-text