• Rahimi SharbafFatemehFYas Hospital, Tehran University of Medical Sciences, Tehran, Iran., Mahboobeh Shirazi, Mansooreh Haghiri, Mamak Shariat, Shirin Niroomanesh, Marjan Ghaemi, and Sakineh Mirzaei Khalilabadi.
• Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
• Arch Iran Med. 2022 Jan 1; 25 (1): 6-11.

BackgroundSelective reduction of the fetus is one of the therapeutic methods in complicated monochorionic twins. The present study aimed to investigate the success rate and perinatal outcomes of selective reduction using radiofrequency ablation (RFA) in monochorionic multiple pregnancies with a hydropic fetus.MethodsThis prospective interventional single-arm study was conducted in a referral hospital from 2017 to 2019. Totally, 27 complicated monochorionic twin and triplet pregnancies underwent RFA to occlude the umbilical vein of the hydropic fetus. The participants were followed until 2 months post-delivery. Procedure success rate, survival rate, gestational age at delivery, and neonatal outcome were evaluated.ResultsThe umbilical cord in 26 (96.2%) cases was successfully occluded by RFA with no maternal complications. Live birth was within 75%. The mean±SD age at delivery was 34.4±3.83 weeks. The gestational age at delivery in TTTS (twin-to-twin transfusion syndrome)-induced hydrops was significantly lower than the non-TTTS hydrops group (P=0.003). Four cases experienced preterm premature rupture of the membranes (PPROM) before 34 weeks. Of all viable neonates, 8 cases were admitted to the neonatal intensive care unit (NICU). In 2 months follow-up post-delivery, all neonates had normal findings without any adverse outcomes.ConclusionSelective reduction by RFA in complicated monochorionic pregnancies with a hydropic fetus may be a safe method with a high success rate and 100% neonatal survival. This method may be optimal for feticide in non-TTTS hydropic twins.2022 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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