双绒毛膜三羊膜囊三胎妊娠射频消融减胎病例临床结局分析

目的:探讨射频消融术（radiofrequency ablation， RFA）对双绒毛膜三羊膜囊（dichorionic triamniotic，DCTA）三胎选择性减胎的安全性以及影响妊娠结局的因素。方法:采用回顾性队列研究方法收集2016年1月1日至2020年1月1日期间在南方科技大学第一附属医院深圳市人民医院产...

Analysis of the clinical outcome of dichorionic triamniotic triplets after selective feticide by radiofrequency ablation

Objective To investigate the safety of selective feticide by radiofrequency ablation(RFA)in dichorionic triamniotic(DCTA)triplets and factors related to the clinical outcome.Methods A retrospective cohort study was designed to review the clinical records and pregnancy outcome of DCTA triplets patients who underwent RFA for selective feticide performed at the First Affiliated Hospital of Southern University of Science and Technology,Shenzhen People's Hospital from January 1,2016 to January 1,2020.Placentas were collected after delivery for gross examination and perfusion study with the mixture of vinylidene chloride and self-curing denture acrylic.Results A total of 12 DCTA cases were recruited.Selective feticide by RFA were performed at a mean gestational age of 15.6 weeks,and cases delivered at a mean gestational age of 36.9 weeks(34+4-38+2 weeks).Eight of the cases undertook invasive prenatal diagnosis weeks after RFA.The interval between RFA to delivery and gestational ages at delivery were similar between women undertook prenatal diagnosis and those who did not(P>0.05).Six of the 23 newborns(26%)were small for gestational age.The average birth weight of either monochorionic singleton fetus or the remained co-twin of the monochorionic diamniotic(MCDA)twin as lower than that of singleton pregnancy(P<0.001).One case of DCTA(8.3%)underwent intrauterine fetal death of the MCDA co-twin 4 h after RFA.Fetal tachycardia and cessation of fetal movement of the co-twin were observed before death.By the time of delivery,placental examination revealed the pale anemia look of the placental part of the co-twin and the reddish appearance of the part of the reduced fetus,which suggested a hypovolemic shock after an uncompleted RFA as the cause of co-twin death.A total of 10 MCDA placentas from cases with a living MCDA co-twins were collected.Various degree of placental perfusion on the reduced fetal side of placenta was noticed in nine cases.The co-twin with the placenta which did not have such kind of perfusion had a birth weight at the lowest percentile.Conclusion Selective feticide by RFA is a safe procedure for DCTA triplet,and prenatal diagnosis has no adverse impact on pregnancy outcome.Ultrasound monitoring of fetal heart rate and fetal movement of the MCDA co-twin after RFA is helpful for predicting clinical outcome.Postnatal placental examination provides clues for adverse outcome,and the growth potential of the MCDA co-twin might be related to the type of anastomosis between the two fetuses.