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- Title
Risk Factors for Co-Twin Fetal Demise following Radiofrequency Ablation in Multifetal Monochorionic Gestations.
- Authors
Gabby, Lauryn C.; Chon, Andrew H.; Korst, Lisa M.; Llanes, Arlyn; Chmait, Ramen H.
- Abstract
<bold>Background: </bold>Umbilical cord occlusion via radiofrequency ablation (RFA) is utilized to maximize outcomes of the co-twin in complicated multifetal monochorionic (MC) gestations. However, post-procedure co-twin fetal demise is of concern.<bold>Objective: </bold>The aim of this study was to determine risk factors for co-twin fetal demise following RFA.<bold>Methods: </bold>This is a retrospective study of MC multiples that underwent RFA. Indications for RFA included twin reversed arterial perfusion (TRAP) sequence, selective fetal growth restriction (sFGR) type II, discordant lethal anomalies, and twin-twin transfusion syndrome (TTTS) with proximate placental cord insertion sites. The primary outcome was co-twin fetal demise. Bivariate analyses and multiple logistic regression modeling of identified risk factors were conducted.<bold>Results: </bold>Of 36 patients studied, surgical indications were: TRAP (n = 15, 41.7%), sFGR (n = 10, 27.8%), discordant anomalies (n = 9, 25.0%), and TTTS (n = 2, 5.6%). Nine patients (25.0%) experienced a co-twin fetal demise. In multiple logistic regression analysis, fetal growth restriction (FGR) of one co-twin was associated with increased risk of co-twin fetal demise (OR = 10.85, 95% CI 1.03-114.48, p = 0.0474) and a preoperative diagnosis of TRAP was protective against fetal demise (OR = 0.06, 95% CI 0.00-0.84, p = 0.0368).<bold>Conclusion: </bold>Co-twin FGR was associated with an increased risk of post-RFA demise. When compared to other indications, patients with TRAP sequence were less likely to have a co-twin demise.
- Subjects
CATHETER ablation; FETAL growth retardation; FETOFETAL transfusion; MULTIPLE regression analysis; LOGISTIC regression analysis; BIVARIATE analysis
- Publication
Fetal Diagnosis & Therapy, 2020, Vol 47, Issue 11, p817
- ISSN
1015-3837
- Publication type
Journal Article
- DOI
10.1159/000509401