title: Clinical Outcomes after Selective Fetal Reduction of Complicated Monochorionic Twins with Radiofrequency Ablation and Bipolar Cord Coagulation.
abstract: OBJECTIVE
  To review pregnancy outcomes, complication rates and neonatal neural development of selective termination procedures for complicated monochorionic (MC) twins.
  
  
  METHODS
  This was a retrospective review of the pregnancies that underwent selective reduction with radiofrequency ablation (RFA) and bipolar cord coagulation (BCC) in our institution.
  
  
  RESULTS
  Forty-eight cases underwent selective reduction with BCC and the remaining 45 with RFA. Overall survival was not statistically different between the RFA and BCC groups (71.1 and 62.5%, p = 0.379). With regard to the indications, the survival rates were not significantly different for twin to twin transfusion syndrome, twin reversed arterial perfusion, discordant anomalies and selective intrauterine growth restriction. Preterm premature rupture of membrane was not statistically different between the BCC and RFA groups (47.9 and 33.3%, p = 0.153). Five foetuses presented with abnormal middle cerebral artery-peak systolic velocity in the BCC group and 4 in the RFA group (p = 0.829). In the BCC group, neurological injury was detected in 2 neonates, presenting with cerebral dysplasia on MR scanning. In the RFA group, intracranial haemorrhage Grade III was detected in one neonate with cranial ultrasound (p = 0.607).
  
  
  CONCLUSIONS
  Overall survival and complication rates following selective reduction in complicated MC twin pregnancies is similar irrespective of whether the reduction was performed using RFA or BCC. Key Message: It seems that selective reduction in MC pregnancies with RFA does not carry a significant decrease in the overall survival and complication rates than the cases with BCC. According to our data, neurodevelopmental impairment of the co-twins is relatively seldom after selective reduction.
authors.affiliation: Department of Ultrasonic Medicine, Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Ruan
authors.initials: R
authors.lastname: Peng
authors.forename: Hong-Ning
authors.initials: HN
authors.lastname: Xie
authors.forename: Mei-Fang
authors.initials: MF
authors.lastname: Lin
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Yang
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhou
authors.forename: Hui-Qing
authors.initials: HQ
authors.lastname: Chen
authors.forename: Yun-Xiao
authors.initials: YX
authors.lastname: Zhu
mesh_terms: D017115:Catheter Ablation; D004200:Diseases in Twins / Q000601:surgery*; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D009420:Nervous System / Q000254:growth & development*; D009422:Nervous System Diseases / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects / Q000379:methods*; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D014470:Umbilical Cord / Q000601:surgery*