title: Fetal reduction by bipolar cord coagulation in managing complicated monochorionic multiple pregnancies: preliminary experience in China.
abstract: BACKGROUND
  Monochorionic multiple pregnancies (MMPs) are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs.
  
  
  METHODS
  Using ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs (5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction). One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different indications. Data regarding the operations, complications and neonatal outcomes were analyzed.
  
  
  RESULTS
  Cord occlusions were successfully performed in 13/14 (93%) cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 (85%). Three operation-related complications occurred (21%), including membrane rupture of the terminated sac (1 case), preterm labor at 28 weeks gestation (1 case), and chorioamniotic membrane separation (1 case). Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin.
  
  
  CONCLUSIONS
  The application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited.
authors.affiliation: Fetal Medicine Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
authors.forename: Zhi-ming
authors.initials: ZM
authors.lastname: He
authors.forename: Qun
authors.initials: Q
authors.lastname: Fang
authors.forename: Yong-zhong
authors.initials: YZ
authors.lastname: Yang
authors.forename: Yan-min
authors.initials: YM
authors.lastname: Luo
authors.forename: Jun-hong
authors.initials: JH
authors.lastname: Chen
authors.forename: Yong-zhen
authors.initials: YZ
authors.lastname: Chen
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhou
authors.forename: Min-Ling
authors.initials: ML
authors.lastname: Chen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011272:Pregnancy, Multiple; D014470:Umbilical Cord / Q000601:surgery*