Objective: To assess the effectiveness of radiofrequency ablation (RFA) in the treatment of multiple pregnancies. Methods: In this retrospective study, 84 cases (total 174 fetuses) of complex monochorionic pregnancies treated with RFA for selective fetal reduction were analyzed. All cases were managed in the Guangdong Women and Children Hospital from January 2015 to January 2018. Indications for offering RFA, details of the procedure and pregnancy outcomes were collected and analyzed. Results: (1)The rate of miscarriage and fetal intrauterine death was 21% (18/84), termination of pregnancy because of fetal malformation or oligohydramnion occurred in 10% (8/84) of cases. Total live birth rate was 69% (58/84) and the gestation age at delivery was (35.0±3.0) weeks. (2) The live birth rate of twin reversed arterial perfusion sequence (TRAPS) was the lowest (6/11), followed by twin to twin transfusion syndrome (TTTS; 66%, 27/41), structural or genetic abnormalities of one fetus in monochorionic twin pregnancy (10/14), triplet pregnancy reduction (4/6) and selective intrauterine growth restriction (sIUGR) (11/12). (3) The live birth rate was 67% (20/30) in stage Ⅲ of TTTS and 7/11 in the stage Ⅳ of TTTS (P>0.05). The average gestational age was (33.6±3.0) weeks in stage Ⅲ of TTTS compared with (36.5±2.4) weeks in the stage Ⅳof TTTS (P<0.05). Conclusions: RFA appears to be a reliable option for selective fetal reduction in monochorionic multiple pregnancies. The indication of RFA is an influencing factor on its pregnancy outcomes. Type Ⅱand type Ⅲ sIUGR may choose this technique as a priority. Compared with stage Ⅲ of TTTS, the live birth rate and the gestation age at delivery in stage Ⅳ of TTTS, there are no significant differences.
目的： 探讨射频消融术（RFA）治疗多胎妊娠的围产结局及影响因素。 方法： 回顾性分析2015年1月1日至2018年1月31日在广东省妇幼保健院行RFA减胎的84例单绒毛膜多胎妊娠孕妇（共174例胎儿）的临床资料，分析其围产结局及影响因素。 结果： （1）围产结局：84例孕妇中，21%（18/84）行RFA减胎后流产或胎死宫内，10%（8/84）术后因胎儿异常或羊水过少等原因引产；69%（58/84）的孕妇分娩活婴，分娩孕周为（35.0±3.0）周。（2）影响因素分析：不同减胎指征中，双胎动脉反向灌注序列征（TRAPS）和双胎输血综合征（TTTS）保留胎儿的存活率较低，分别为6/11和66%（27/41）；双胎之一胎儿结构异常、三胎减胎及双胎选择性宫内生长受限（sIUGR）的孕妇，其保留胎儿的存活率分别为10/14、4/6及11/12。不同TTTS分期的孕妇中，TTTS Ⅲ期、Ⅳ期孕妇减胎后保留胎儿的存活率分别为67%（20/30）、7/11，两者比较，差异无统计学意义（P>0.05）；两者的分娩孕周分别为（33.6±3.0）、（36.5±2.4）周，两者比较，差异有统计学意义（P<0.05）。 结论： RFA用于单绒毛膜多胎妊娠减胎有效。减胎指征是影响保留胎儿预后的重要影响因素，Ⅱ型或Ⅲ型sIUGR可考虑优选该术；与TTTS Ⅲ期相比，TTTS Ⅳ期减胎后保留胎儿的预后无明显差异。.
Keywords: Pregnancy reduction, multifetal; Prognosis; Radiofrequency ablation.