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

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.

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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.

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Contributing factors of fetal death following radiofrequency ablation in complicated monochorionic multiple pregnancies

10.21203/rs.2.18996/v1 ◽

2019 ◽

Author(s):

Fatemeh Rahimi-Sharbaf ◽

Mansooreh Haghiri ◽

Shirin Niromanesh ◽

Mahboobeh Shirazi ◽

Arezoo Arabipoor ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Fetal Death ◽

Perinatal Outcomes ◽

Treatment Method ◽

Cross Sectional Study ◽

Multiple Pregnancies ◽

Medical Sciences ◽

Contributing Factors ◽

Cross Sectional ◽

Arterial Perfusion

Abstract Background Radiofrequency ablation is considered as an optional treatment method in complicated monochorionic (MC) twin pregnancies. The purpose of this study is to investigate the main factors of fetal death after such treatment procedure. The study also compares the perinatal outcomes among various groups of indication and gestational age (GA) at procedure.Methods This cross-sectional study considers 195 cases of MC multiple pregnancies including one twin with twin-twin transfusion syndrome, selective intrauterine growth restriction, sever anomaly and twin reversed arterial perfusion sequence(TRAP) which underwent selected reduction using RFA from 2016 to 2018 at Yas Hospital, related to Tehran University of Medical sciences. The GA at RFA categorized as 16- 19 +6 wks., 20-23 +6 wks., and 24-28 wks. The analysis of risk factors of fetal death after RFA is based on multivariable logistic regression model.Results The result of analysis reveals that the rate of co-twin anemia after RFA in anomaly indication was higher than the other indications significantly (p=0.038) while according to GA categories, it is significantly lower in 20-23 +6 wks. (p=0.016). Three independent significant factors contributing in fetal death after RFA were co-twin anemia after RFA, TRAP and anomaly indications of RFA and GA at RFA, respectively.Conclusions The co-twin anemia after RFA is found the most contributing factor of fetal death. As the results show that the rate of co-twin anemia after RFA is significantly low in 20-23 +6 weeks of GA, such GA is suggested for RFA procedure to reduce the fetal death.

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Role of Ultrasound in Diagnosis of Fetus Acardius Acephalus in Multiple Pregnancies

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0039-1677781 ◽

2018 ◽

Vol 4 (02) ◽

pp. 085-087

Author(s):

Ruby Yadav ◽

Nishi Choudhary

Keyword(s):

Heart Failure ◽

Case Report ◽

Gestational Age ◽

Preterm Labor ◽

Perinatal Outcomes ◽

Therapeutic Interventions ◽

Multiple Pregnancies ◽

Triplet Pregnancy ◽

Gestational Age At Delivery

AbstractThis case report describes an acardiac fetus of the acephalus phenotype in a triplet pregnancy. The diagnosis was confirmed at 13 weeks. In the absence of signs of heart failure in the co-fetus, the pregnancy was managed conservatively. The pregnancy was complicated by preterm labor and the fetuses were delivered at 23 + 4 weeks. Also, the perinatal outcomes of triplet pregnancies complicated by an acardiac fetus, where the median gestational age at delivery is 23 to 24 weeks, are summarized, and the possible therapeutic interventions have been discussed.

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Fetal loss rate after second trimester amniocentesis at different gestational age

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1034/j.1600-0412.1999.780104.x ◽

1999 ◽

Vol 78 (1) ◽

pp. 10-14 ◽

Cited By ~ 1

Author(s):

Sissel Saltvedt ◽

Harald Almström

Keyword(s):

Gestational Age ◽

Loss Rate ◽

Fetal Loss ◽

Second Trimester

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Fetal loss rate after second trimester amniocentesis at different gestational age

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1080/j.1600-0412.1999.780104.x ◽

1999 ◽

Vol 78 (1) ◽

pp. 10-14 ◽

Cited By ~ 20

Author(s):

Sissel Saltvedt ◽

Harald Almström

Keyword(s):

Gestational Age ◽

Loss Rate ◽

Fetal Loss ◽

Second Trimester

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IN UTERO TRANSPLANTATION OF HUMAN STEM CELLS USING AN ANIMAL MODEL: A COMPARISON BETWEEN TWO TECHNIQUES

Cluj Veterinary Journal ◽

10.52331/cvj.v15i1.2 ◽

2009 ◽

Vol 15 (1) ◽

pp. 5-10

Author(s):

Daria GROZA ◽

Emoke PALL ◽

Mihai CENARIU ◽

Raul POP ◽

Nicolae Nicolae ◽

...

Keyword(s):

Stem Cells ◽

Cord Blood ◽

Loss Rate ◽

Fetal Loss ◽

In Utero ◽

Needle Puncture ◽

Ultrasound Guided ◽

In Utero Transplantation ◽

Blood Stem Cells ◽

Cord Blood Stem Cells

Objective: The purpose of this study was to assess the feasibility of in utero stem cell transplantation of human umbilical cord blood stem cells in fetal sheep and to compare two different techniques of in utero transplantation, namely ultrasound-guided in utero transplantation and in utero transplantation after midline celiotomy. Study design: Umbilical cord blood units were collected from term deliveries, after obtaining written informed consent. Human cord blood–derived, CD34+ stem cells were injected into the peritoneal cavity of 60- to 65-day-old ovine fetuses by using 2 different techniques: ultrasound-guided transabdominal percutaneous needle puncture and midline celiotomy with the exposure of the pregnant uterus. Engraftment was determined after birth by flow cytometry with use of human-specific anti-CD 34/45 antibodies. Results: We obtained a total of 3 chimeric lambs. Using the midline celiotomy technique the fetal loss rate was 75% and only 33,3% when using ultrasound-guided transabdominal percutaneous needle puncture technique. Engraftment of donor cells was found in all fetuses, with a mean level of 1.4% in fetal peripheral blood and 3.3% in fetal bone marrow. Conclusion: This preliminary study indicates that in utero stem cell transplantation of human hematopoietic cord blood stem cells in fetal lambs is feasible and effective in terms of hematopoietic engraftment. We also concluded that the ultrasound-guided transabdominal percutaneous needle puncture technique is more effective than performing a midline celiotomy in terms of fetal loss rate.

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Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes

Fetal Diagnosis and Therapy ◽

10.1159/000519639 ◽

2021 ◽

pp. 1-10

Author(s):

Peña Dieste Pérez ◽

Luis M. Esteban ◽

Ricardo Savirón-Cornudella ◽

Faustino R. Pérez-López ◽

Sergio Castán-Mateo ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Entire Study ◽

Birth Weight Percentile ◽

Gestational Age At Delivery ◽

Study Population ◽

The Difference ◽

Relationship Of ◽

The Relationship

Objective: This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). Material and Method: It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score <7, arterial cord blood pH <7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01–10.0, 10.01–20.0, 20.01–30.0, 30.01–40.0, 40.01–50.0, and >50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. Results: The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1–40.7) and in pregnancies with APOs 40.3 (49.4–41.0), p < 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (p < 0.001). The RR was 1.63 (95% CI: 1.365–1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581–2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56–0.61, p < 0.001). Conclusion: Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of >40 percentile points.

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EP19.06: Gestational age at delivery, Doppler indices and perinatal outcomes in preterm late onset fetal growth restriction as for Delphi's criteria

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.21508 ◽

2019 ◽

Vol 54 (S1) ◽

pp. 352-353

Author(s):

K. Melchiorre ◽

M. Rosati ◽

E. Clementini ◽

I. D'Emilio ◽

S. Di Valerio ◽

...

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Fetal Growth Restriction ◽

Late Onset ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Gestational Age At Delivery ◽

Doppler Indices

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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.

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