Risk Factors for Co-Twin Fetal Demise following Radiofrequency Ablation in Multifetal Monochorionic Gestations

Lauryn C Gabby; Andrew H Chon; Lisa M Korst; Arlyn Llanes; Ramen H Chmait

doi:10.1159/000509401

Risk Factors for Co-Twin Fetal Demise following Radiofrequency Ablation in Multifetal Monochorionic Gestations

Fetal Diagn Ther. 2020;47(11):817-823. doi: 10.1159/000509401. Epub 2020 Aug 7.

Authors

Lauryn C Gabby¹, Andrew H Chon¹, Lisa M Korst², Arlyn Llanes¹, Ramen H Chmait³

Affiliations

¹ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
² Childbirth Research Associates, North Hollywood, California, USA.
³ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA, jennyrenaeking@gmail.com.

PMID: 32772022
DOI: 10.1159/000509401

Abstract

Background: 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.

Objective: The aim of this study was to determine risk factors for co-twin fetal demise following RFA.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Monochorionic twins; Radiofrequency ablation; Selective reduction; Umbilical cord occlusion.