Radio frequency ablation in complicated monochorionic multiple
pregnancy: prediction of perinatal outcome and comparison of two
different needle insert angles
Abstract
Objective To assess the risk factors for adverse pregnancy outcome in
the RFA selective reduction procedure for complicated multiple
pregnancies and to compare the pregnancy outcomes between two radio
frequency needle insert angles, abdominal and dorsal insert angle.
Methods In order to retain at least one fetus, 145 pregnant women with
complicated monochorionic multiple pregnancy chose radio frequency
ablation to do selective reduction. Compare the procedure
characteristics and pregnancy outcomes of the two different needle
insert angles groups by SPSS 21.0. Results The RFA procedure in 145
complicated monochorionic multiple pregnancies were all conducted
successfully, 116 cases through abdominal insert angle, and 29 cases
through dorsal insert angle. Cox regression analysis indicated that the
survival curve of fetal survival time interval after the procedure
between the two needle insert angles were statistically
different(P<0.001), with two significant predictors, cervical
length (RR=0.969, P=0.043) and the gestational age before the procedure
(RR=1.205, P<0.001) . Multivariable logistic analysis showed
that compared to live birth at term, the risk of miscarriage,termination
and IUFD were statistically higher when the cervical length was less
than 35mm(P<0.001).Even though the survival rate was
non-significant different within the indications(P=0.623), the pregnancy
with live born fetus showed a higher trend in IUGR &TTT(90.9%) than
other indications. Conclusion The interval between RFA to delivery
specific survival curve showed a significant improvement with the
abdominal needle insert angle compared with dorsal insert angle. The
cervical length and gestational age before RFA procedure were two risk
factors about the adverse pregnant outcome.