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

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

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

Single Dose of Methotrexate Therapy Followed By Suction Curettage for Management of Cesarean Scar Pregnancy

Obstetrics Gynecology and Reproductive Sciences ◽

10.31579/2578-8965/028 ◽

2019 ◽

Vol 3 (1) ◽

pp. 01-04

Author(s):

Hend S Saleh ◽

Hala E Sherif ◽

Eman M Mahfouz

Keyword(s):

Single Dose ◽

Gestational Age ◽

Wedge Resection ◽

Rare Condition ◽

Prospective Clinical Study ◽

Maternal Complications ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Suction Curettage ◽

The Mean

Objective Implantation of the pregnancy in a cesarean scar is a rare condition named ; Cesarean scar pregnancy (CSP). Maternal complications can be prevented with the early diagnosis and an appropriate management .It is a Prospective clinical study to evaluate the efficacy and success rate of single dose use of methotrexate (MTX) followed by dilation and suction (D&S) regimen in management of women with cesarean scar pregnancy (CSP) . Methods 50mg of MTX in the form of a single dose Intramuscular injection then cervical dilatation and suction aspiration with a Karman cannula(D&S) under guidance of ultrasound after 48 preeceeded by vaginal misoprostol 2 tablet (200 mg) 4 hours ago. Results The mean gestational age at diagnosis was (8.5±1.6 ) and The mean level of serum b-human chorionic gonadotropin was (7424±2.560 ) and The mean gestational age of pregnancy was (8.5±1.6 ) .88.7% is the successive rate without complication need intervention, 2 (5.7%) patients needed intrauterine Foley's catheter for 24 hours as a mechanical hemostasis . 2 (5.7 %) had laparotomy with wedge resection of the gestational sac lesion and successful repair of the uterine defect and one (2.8 %)underwent subtotal hysterectomy. Conclusion: Systemic single dose MTX injection followed by D&S is an effective and harmless management for CSP. Nevertheless more studies are required to prove the efficiency, safety, and reproductive outcome of variant modalities in treatment of CSP.

Download Full-text

Twin reversed arterial perfusion (TRAP) sequence managed at 11+6 weeks with radiofrequency ablation

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2013-0001 ◽

2014 ◽

Vol 3 (2) ◽

Author(s):

Gwangjun Kim ◽

Min Young Park ◽

Seung Su Han

Keyword(s):

Case Report ◽

Radiofrequency Ablation ◽

Gestational Age ◽

Feeding Artery ◽

First Line ◽

Arterial Perfusion ◽

Trap Sequence ◽

Twin Reversed Arterial Perfusion ◽

Line Management

AbstractRadiofrequency ablation (RFA) has become widely accepted as first-line management for twin reversed arterial perfusion (TRAP) sequence. Most RFA procedures have been performed using RFA needles of 14–17 gauge (G) focusing on an acardiac mass at an average age of 21 weeks of gestation (17–24 weeks). In this case report, we describe treatment of TRAP sequence using RFA with a 20 G needle focusing a feeding artery on the placental surface at gestational age of 11+6.

Download Full-text

Selective Reduction Using Intravascular Potassium Chloride Injection after Laser Surgery for Twin-Twin Transfusion Syndrome

Fetal Diagnosis and Therapy ◽

10.1159/000431255 ◽

2015 ◽

Vol 39 (4) ◽

pp. 306-310

Author(s):

Ramen H. Chmait ◽

Eftichia V. Kontopoulos ◽

Marc Jackson ◽

Janet Horenstein ◽

Ilan Timor-Tritsch ◽

...

Keyword(s):

Potassium Chloride ◽

Gestational Age ◽

Laser Surgery ◽

Laser Photocoagulation ◽

Selective Reduction ◽

Monochorionic Twins ◽

Maternal Request ◽

Neurological Sequelae

Selective reduction (SR) via intravascular potassium chloride (KCl) injection is contraindicated in monochorionic twins due to the presence of placental vascular communications, which may serve as a conduit for inter-twin passage of KCl or allow exsanguination of the living twin into the demised twin. After successful selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS), the twins' circulatory systems are rendered independent. Theoretically, intravascular KCl injection into one twin after successful SLPCV should not result in passage of the feticidal agent nor cause hemodynamic alterations in the co-twin. We describe 3 cases of 1,069 patients (0.3%) that underwent SLPCV for TTTS between 2003 and 2013 and subsequent SR. SLPCV was successfully completed at 18⁰, 226, and 23⁰ weeks' gestational age for Quintero stages III, IV, and III TTTS, respectively. SR via intravascular KCl injection was later performed at maternal request due to the risk of neurological compromise in one twin at 226, 254, and 236 weeks' gestational age. All co-twins survived after SR, and no neurological sequelae were suspected after birth. Further study is necessary before SR can be routinely considered after laser surgery for TTTS.

Download Full-text

Single Dose of Methotrexate Therapy Followed By Suction Curettage for Management of Cesarean Scar Pregnancy

Obstetrics Gynecology and Reproductive Sciences ◽

10.31579/2578-8965/028. ◽

2019 ◽

Vol 3 (3) ◽

pp. 01-05

Author(s):

Hend Saleh

Keyword(s):

Single Dose ◽

Gestational Age ◽

Wedge Resection ◽

Rare Condition ◽

Prospective Clinical Study ◽

Maternal Complications ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Suction Curettage ◽

The Mean

Download Full-text

Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10102152 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2152

Author(s):

Hadar Rosen ◽

Yossi Bart ◽

Rita Zlatkin ◽

Liat Ben-Sira ◽

Dafna Ben Bashat ◽

...

Keyword(s):

Cohort Study ◽

Vertical Transmission ◽

Prospective Cohort Study ◽

Gestational Age ◽

Prospective Cohort ◽

Perinatal Outcomes ◽

Neonatal Outcomes ◽

Second Trimester ◽

Early Gestation ◽

The Mean

A novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus causing coronavirus disease 2019 (COVID-19) disease, which emerged as a global pandemic. Data regarding the implications of COVID-19 disease at early gestation on fetal and obstetric outcomes is scarce. Thus, our aim was to investigate the effect of first and second trimester maternal COVID-19 disease on fetal and perinatal outcomes. This was a prospective cohort study of pregnant women with a laboratory-proven SARS-COV-2 infection contracted prior to 26 weeks gestation. Women were followed at a single tertiary medical center by serial sonographic examinations every 4–6 weeks to assess fetal well-being, growth, placental function, anatomic evaluation and signs of fetal infection. Amniocentesis was offered to assess amniotic fluid SARS-COV-2-PCR (polymerase chain reaction) and fetal brain magnetic resonance imaging (MRI) was offered at 30–32 weeks gestation. Demographic, obstetric and neonatal data were collected from history intake, medical charts or by telephone survey. Perinatal outcomes were compared between women infected at first vs. second trimester. 55 women with documented COVID-19 disease at early gestation were included and followed at our center. The mean maternal age was 29.6 ± 6.2 years and the mean gestational age at viral infection was 14.2 ± 6.7 weeks with 28 (51%) women infected at the first trimester and 27 (49%) at the second trimester. All patients but one experienced asymptomatic to mild symptoms. Of 22 patients who underwent amniocentesis, none had evidence of vertical transmission. None of the fetuses exhibited signs of central nervous system (CNS) disease, growth restriction and placental dysfunction on serial ultrasound examinations and fetal MRI. Pregnancies resulted in perinatal survival of 100% to date with mean gestational age at delivery of 38.6 ± 3.0 weeks and preterm birth <37 weeks rate of 3.4%. The mean birthweight was 3260 ± 411 g with no cases of small for gestational age infants. The obstetric and neonatal outcomes were similar among first vs. second trimester infection groups. We conclude SARS-CoV-2 infection at early gestation was not associated with vertical transmission and resulted in favorable obstetric and neonatal outcomes.

Download Full-text

Clinical Outcomes after Selective Fetal Reduction of Complicated Monochorionic Twins with Radiofrequency Ablation and Bipolar Cord Coagulation

Gynecologic and Obstetric Investigation ◽

10.1159/000445291 ◽

2016 ◽

Vol 81 (6) ◽

pp. 552-558 ◽

Cited By ~ 13

Author(s):

Ruan Peng ◽

Hong-Ning Xie ◽

Mei-Fang Lin ◽

Jian-Bo Yang ◽

Yi Zhou ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Clinical Outcomes ◽

Monochorionic Twins ◽

Fetal Reduction ◽

Selective Fetal Reduction

Download Full-text

Pregnancy after liver transplant: maternal and perinatal outcomes

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04104-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Izabela Marzec ◽

Aleksandra Słowakiewicz ◽

Jolanta Gozdowska ◽

Olga Tronina ◽

Marek Pacholczyk ◽

...

Keyword(s):

Liver Transplantation ◽

Perinatal Outcomes ◽

First Trimester ◽

Reproductive Age ◽

Maternal Complications ◽

Optimal Method ◽

Life Saving ◽

Transplant Center ◽

Gestational Week ◽

The Mean

Abstract Background Liver transplantation is a life-saving and successful therapeutic procedure which is more and more frequent worldwide, also among women of reproductive age. Consequently, there is an increasing number of reports of pregnancy following liver transplantation, but doubts still exist regarding preconception counseling and the optimal method of managing pregnancy. The aim of this study was to report and evaluate pregnancy outcomes in women who had undergone liver transplantation. Methods We retrospectively analyzed female patients after orthotopic liver transplantation who reported pregnancy and were under medical care of a single transplant center. Results We identified 14 pregnancies in 10 women who had undergone liver transplantation (12 childbirths, one induced abortion due to fetal death in the first trimester, one pregnancy is still ongoing). Causes of transplantation include congenital or acquired disorders and the most common indication was autoimmune hepatitis (50%). The mean age at the point of transplantation was 28.5 (range 21–36), mean maternal age at pregnancy was 32 (range 26–43), and transplant-to-pregnancy interval was 4.07 years (range 1.5–7). The mean gestational week was 36.67 (range 31–40). Immunosuppression was maintained with combinations of prednisone (n = 11), tacrolimus (n = 13), and azathioprine (n = 8) prior to and during pregnancy. Two pregnancies were unintended, so women took mycophenolate mofetil in the first weeks of gestation. Another two women stopped taking azathioprine due to increasing anemia. Maternal complications included increase of aspartate transaminase and alanine transaminase (n = 2), anemia (n = 4) and hyperthyroidism (n = 2). Among the 12 childbirths, five (41.67%) were preterm. Only five women entered labor spontaneously, while seven (58,33%) had cesarean delivery. Conclusions Pregnancy after liver transplantation can achieve relatively favorable outcomes. Liver transplantation does not influence women’s fertility and, during pregnancy, we report low rates of minor graft complications. A multidisciplinary team should be involved in contraceptive, fertility and consequently pregnancy counseling of female transplant recipients.

Download Full-text

Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center

Neurosurgical FOCUS ◽

10.3171/2019.8.focus19438 ◽

2019 ◽

Vol 47 (4) ◽

pp. E12 ◽

Cited By ~ 2

Author(s):

Giorgio Carrabba ◽

Francesco Macchini ◽

Isabella Fabietti ◽

Luigi Schisano ◽

Giulia Meccariello ◽

...

Keyword(s):

Gestational Age ◽

Fetal Surgery ◽

Preoperative Assessment ◽

In Utero ◽

Maternal Complications ◽

Preliminary Results ◽

Neurological Outcomes ◽

Csf Leakage ◽

Hindbrain Herniation ◽

The Mean

OBJECTIVERecent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors’ aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalus, and radiological outcomes.METHODSPreoperative assessment included clinical examination, ultrasound imaging, and MRI of the fetus. Patients underwent purely fetoscopic in utero MMC repair, followed by postoperative in utero and postnatal MRI. All participants received multidisciplinary follow-up.RESULTSFive pregnant women carrying fetuses affected by MMC signed informed consent for the fetoscopic treatment of the defect. The mean MMC size was 30.4 mm (range 19–49 mm). Defect locations were L1 (2 cases), L5 (2 cases), and L4 (1 case). Hindbrain herniation and ventriculomegaly were documented in all cases. The mean gestational age at surgery was 28.2 weeks (range 27.8–28.8 weeks). Fetoscopic repair was performed in all cases. The mean gestational age at delivery was 33.9 weeks (range 29.3–37.4 weeks). After surgery, reversal of hindbrain herniation was documented in all cases. Three newborns developed signs of hydrocephalus requiring CSF diversion. Neurological outcomes in terms of motor level were favorable in all cases, but a premature newborn died due to CSF infection and sepsis.CONCLUSIONSThe authors’ preliminary results suggest that fetoscopic treatment of MMC is feasible, reproducible, and safe for mothers and their babies. Neurological outcomes were favorable and similar to those in the available literature. As known, prematurity was the greatest complication.

Download Full-text

Conjoined twins in dichorionic diamniotic triplet pregnancy: a report of three cases and literature review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04165-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongyan Liu ◽

Chunyan Deng ◽

Qing Hu ◽

Hua Liao ◽

Xiaodong Wang ◽

...

Keyword(s):

Perinatal Outcomes ◽

Selective Reduction ◽

Good Health ◽

Conjoined Twins ◽

Multidisciplinary Teams ◽

Triplet Pregnancy ◽

Management Options ◽

Monochorionic Twins ◽

Healthy Female ◽

Female Baby

Abstract Background Conjoined twins are a rare and serious complication of monochorionic twins. The total incidence is 1.5 per 100,000 births, and about 50% are liveborn. Prenatal screening and diagnosis of conjoined twins is usually performed by ultrasonography. Magnetic resonance imaging can be used to assist in the diagnosis if necessary. Conjoined twins in dichorionic diamniotic triplet pregnancy are extremely rare. Case presentation We reported three cases of dichorionic diamniotic triplet pregnancy with conjoined twins. Due to the poor prognosis of conjoined twins evaluated by multidisciplinary teams, selective termination of conjoined twins was performed in three cases. In case 1, selective reduction of the conjoined twins was performed at 16 gestational weeks, and a healthy female baby weighing 3270 g was delivered at 37 weeks. In case 2, the conjoined twins were selectively terminated at 17 weeks of gestation, and a healthy female baby weighing 2760 g was delivered at 37 weeks and 4 days. In case 3, the conjoined twins were selectively terminated at 15 weeks and 2 days, and a healthy female baby weighing 2450 g was delivered at 33 weeks and 6 days. The babies of all three cases were followed up and are in good health. Conclusion(s) Surgical separation is the only treatment for conjoined twins after birth. Early determination of chorionicity and antenatal diagnosis of conjoined twins in triplet gestations are critical for individualized management options and the prognosis of normal triplets. Expecting parents should be extensively counseled by multidisciplinary teams. If there are limitations in successful separation after birth, early selective termination of the conjoined twins by intrathoracic injection of potassium chloride may be a procedure in dichorionic diamniotic triplet pregnancy to improve perinatal outcomes of the normal triplet.

Download Full-text