A case of amniotic band syndrome after fetal reduction by radiofrequency ablation / 中华围产医学杂志

This article reported a survived case of amniotic band syndrome (ABS) following fetal reduction by radiofrequency ablation. The woman conceived monochorionic diamniotic twin pregnancy spontaneously. Prenatal ultrasound at 24 weeks of gestation indicated twin-twin transfusion syndrome (stage Ⅲ), and radiofrequency ablation for fetal reduction was successfully performed after formal consent. At 28 +6 weeks, ultrasound reexamination revealed significant edema in the left foot of the fetus, with banding around the ankle, as well as the strangulation mark and narrowing rings. Fetal ABS (ⅡB stage) was diagnosed after multidisciplinary consultation. An immediate emergency cesarean section was performed and a live male baby was born. A thin amniotic band could be seen wrapping around the left ankle of the newborn for several rounds, with obvious strangulation marks about 1 cm deep into the skin, and significant edema on the dorsum and sole of the foot, and the submalleolus area. The amniotic band was released at once, and the edema faded gradually after surgery. After a follow-up of 28 days, the lower limbs of the newborn became normal.

Effects of selective feticide by radiofrequency ablation and risk factors for prognosis in 75 twins complicated by selective intrauterine growth restriction / 中华围产医学杂志

Objective:To analyze the effects of selective feticide by radiofrequency ablation (RFA) and the risk factors for adverse pregnancy outcomes in twins complicated by selective intrauterine growth restriction (sIUGR) and evaluate the neurodevelopment in live births during a short-term follow-up.Methods:This study retrospectively enrolled 75 twins with sIUGR who underwent RFA for selective feticide and were delivered in the First Affiliated Hospital of Sun Yat-sen University between January 1, 2017 and March 31, 2022. According to the gestational age at the procedure, they were divided into three groups including 16-19 +6 weeks of gestation (Group A, n=16), 20-23 +6 weeks of gestation (Group B, n=44) and ≥24 weeks of gestation (Group C, n=15). They were also grouped according to the presence or absence of twin-twin transfusion syndrome (TTTS): sIUGR with TTTS group ( n=36) and isolated sIUGR group ( n=39). The 39 cases in the isolated sIUGR group were further divided into three groups according to the Doppler flow in the smaller co-twin: type Ⅰ ( n=3), type Ⅱ ( n=27) and type Ⅲ ( n=9). According to pregnancy outcomes, the 75 cases were divided into adverse pregnancy outcome group ( n=49) and non-adverse pregnancy outcome group ( n=26). Statistical analysis was performed using two independent sample t-test, one-way analysis of variance and LSD test, nonparametric test and Nemenyi test, as well as Chi-square test and Fisher's exact test to compare the difference in clinical characteristics and perinatal outcomes among groups. Kaplan-Meier survival curves and Log-rank test were used to analyze the duration of pregnancy after the procedure. Univariate logistic regression analysis was used to identify the risk factors for adverse pregnancy outcomes. Results:(1) The gestational age at the time of procedure was (21.9±2.3) weeks (16.6-26.0 weeks) for all cases. The intertwin estimated fetal weight discordance (ΔEFW) was less and the duration of RFA was shorter in group A than in group B or C [(27.8±8.4)% vs (36.2±12.0)% and (39.8±15.5)%; 7 min (5-14 min) vs 10 min (5-16 min) and 12 min (8-18 min); LSD test or Nemenyi test, P<0.017]. The incidence of TTTS was higher in group A than in group B or C [12/16 vs 43% (19/44) and 5/15; Bonferroni correction, P<0.017]. There was no significant difference in the incidence of premature rupture of membrane, spontaneous abortion, fetal demise, premature delivery and gestational age at delivery between Group A, B and C (all P>0.05). (2) Compared with the isolated sIUGR group, the sIUGR with TTTS group showed less ΔEFW [(29.6±11.4)% vs (40.1±11.8)%, t=3.88, P<0.001], higher incidence of premature rupture of membrane [47% (17/36) vs 21% (8/39), χ2=6.01, P=0.014], lower rate of live births [69% (25/36) vs 95%(37/39), χ2=8.45, P=0.004] and earlier delivery [34.1 weeks (26.7-40.7 weeks) vs 38.0 weeks (29.3-40.0 weeks), Z=311.50, P=0.018]. (3) There was no significant difference in the incidence of premature rupture of membrane, live birth rate or 30-day survival rate among the sIUGR type Ⅰ, Ⅱ and Ⅲ groups (all P>0.05). (4) sIUGR complicated by TTTS was a risk factor for adverse pregnancy outcomes of the co-twin after the procedure ( OR=3.94, 95% CI: 1.40-11.10, P=0.010). (5) Thirteen co-twins presented with cardiac enlargement, myocardial hypertrophy or/and tricuspid regurgitation in routine ultrasound scans before the procedure and nine of them had TTTS. Among them, eight live births were followed up for one month to 4.5 years of age and no abnormality in cardiac function was reported. (6) There were overall 62 live births. Apart from two cases of neonatal death and four lost to follow-up, the other 56 cases were followed up to one month to 5 years of age and two premature infants showed gross motor retardation. Conclusions:The gestational age at RFA has no significant impact on pregnancy outcomes, while sIUGR complicated by TTTS may increase the risk of adverse outcomes after the procedure. After RFA, the overall survival rate of the co-twin in pregnancies with sIUGR is high and no severe neurodevelopmental abnormalities has been found during a short-term follow-up.

Effect of selective feticide at different gestational weeks in double chorionic twin pregnancies on pregnant women and perineonates outcomes / 中国医师进修杂志

Objective:To compare and analyze the pregnant women and perineonates outcomes of selective feticide at different gestational weeks in double chorionic twin pregnancies.Methods:The clinical data of 86 patients with double chorionic twin pregnancies who underwent selective feticide from January 2015 to June 2021 in the General Hospital of Northern War Zone were retrospectively analyzed. The patients were divided into two groups according to different gestational weeks of selective feticide: 23 cases at 14 +3 to 19 +6 gestational weeks (group A), 31 cases at 20 to 27 +6 gestational weeks (group B), 32 cases and at ≥28 gestational weeks (group C). The gestational weeks of delivery, abortion, preterm birth, full-term birth, liveborn infants, surviving infants, birth body mass of liveborn infants, birth body mass of surviving infants, complications in pregnant women, pregnant women and perineonates outcomes and neonatal prognosis were recorded. Results:There were no statistical differences in gestational weeks of delivery, incidence of complications in pregnant women, abortion rate and neonatal survival rate among three groups ( P>0.05); there were statistical differences in preterm birth rate, full-term birth rate, liveborn infants rate, birth body mass of liveborn infants and birth body mass of surviving infants among three groups ( P<0.05). The preterm birth rate in group A was significantly lower than that in group C: 21.7% (5/23) vs. 68.8% (22/32), the full-term birth rate was significantly higher than that in group C: 69.6% (16/23) vs. 28.1% (9/32); the birth body mass of liveborn infants and birth body mass of surviving infants in group A were significantly higher than those in group B and group C: (2 905.7 ± 580.9) g vs. (2 284.4 ± 416.7) and (2 293.8 ± 456.2) g, (2 905.7 ± 580.9) g vs. (2 457.1 ± 527.8) and (2 359.2 ± 482.4) g, the liveborn infants rate in group C was significantly higher than that in group B: 96.9% (31/32) vs. 77.4% (24/31), and there were statistical differences ( P<0.05). The 72 surviving infants were followed up for 3 months to 4 years, and no motor dysfunction and neurological abnormalities occurred. Conclusions:Selective feticide in patients with double chorionic twin pregnancies before 20 weeks of gestation has less complications in pregnant women and good perineonates clinical outcome.

Selective fetal reduction for monochorionic and dichorionic triplet / 中华围产医学杂志

Monochorionic triplet and dichorionic triplet pregnancies result in a higher risk of complications than trichorionic triplet due to its monochorionic part, and often lead to adverse pregnancy outcomes. We discuss the impact of different fetal reduction numbers, object and surgical methods on the outcome of monochorionic triplet and dichorionic triplet pregnancies. Compared with expectant management, several common fetal reduction strategies can reduce the risk of premature birth, prolong gestational weeks, and increase fetal birth weight. Reduction of the fetus with a separate placenta does not avoid the complications of monochorionic twins, and reducing one of the monochorionic pairs might cause the death of the remaining fetus, thereby requiring skilled surgeons. So, reduction of the monochorionic pair was preferred. More study are needed to evaluate the reduction strategy of monochorionic triplet.

Single embryo transfer and multifetal pregnancy reduction: perception and attitude of women seeking assisted reproduction in Nigeria

Background: In-vitro fertilization (IVF) is associated with increased multiple pregnancy and its attendant complications. This study evaluates the attitude and acceptance of single embryo transfer (SET) and multifetal pregnancy reduction (MFPR) by clients assessing assisted reproduction in this region.Methods: A cross sectional survey of patients selected for IVF was conducted. Information on demography, knowledge of IVF procedure and their perception, attitude and acceptability of multiple pregnancy as well as their knowledge, attitude and perception to single embryo transfer and multifetal pregnancy reduction were extracted for statistical analysis.Results: Seventy-three women participated in the study. The mean age was 39 years and mean duration of infertility was 8.6 years. Only 3 (4.1%) respondents agreed to have SET as the overwhelming majority (70) 95.9% preferred 2 or more and they felt the more number of embryo transferred the better the chances of achieving pregnancy. Similarly most respondents, 38.4% (28) did not accept MFPR. Most respondents considered age (63%) and duration of infertility (78.1%) as major influencing factor for rejecting SET. Over 75% of respondents said they will still accept multiple embryos transferred despite knowledge of the possible complications.Conclusions: While most infertile women in our sub region appear to recognize the risks with multiple pregnancy, they are less interested in SET or MFPR because they perceive more embryos transferred as a means to maximize treatment outcome. Government funding, client education and a blastocyst transfer protocol may improve acceptability as well as overall preference for less number of embryos transferred in our environment.

Analysis of clinical characteristics of discordant structural malformations in one of monochorionic diamnionic twins / 中华妇产科杂志

Objective To analyze the clinical characteristics of structural malformations in one of monochorionic diamnionic twins (MCDA). Methods The clinical data of 77 MCDA patients with structural malformations diagnosed by ultrasound were retrospectively reviewed from January 2012 to May 2017. The distribution of structural malformations, prenatal chromosomal karyotyping and pregnancy outcomes were analyzed. Results (1)Among the 77 MCDA patients with structural malformations, the single malformation accounted for 79％(61/77), the multiple malformations accounted for 21％(16/77). And there were a total of 94 types of malformations, the top three malformations were neurological malformations (32％, 30/94), cardiovascular malformations (29％,27/94) and twin reversed arterial perfusion sequence (TRAPS;10％,9/94). (2)Among the 77 patients with structural malformation, 64 cases (83％, 64/77) were examined for fetal chromosomes, of whom 14 cases (22％,14/64) were examined for fetal chromosomes of both twins, with 1 case (1/14) of discordant fetal chromosome. (3)Among the 77 patients, 4 cases (5％, 4/77) with severe fetal malformations terminated pregnancy. Totally 29 cases (38％, 29/77) with severe malformations were treated with selective fetal reduction, among whom 7 cases (24％, 7/29) experienced unexplained fetal death within 24 hours after the operation;2 cases (7％, 2/29) happened inevitable abortion, and 2 cases (7％, 2/29) underwent unexplained fetal death during the late pregnancy. Of the remaining 44 patients (57％,44/77) with expectant treatment, 13 cases (30％, 13/44) occurred twin transfusion syndrome (Ⅱ-Ⅳ), and were treated with fetoscopic laser occlusion. Eight patients had 2 survival twins, 4 patients delivered 1 survival twin, and 1 patient had dead twins. Conclusions The most common malformations in MCDA twins are the nervous malformations, cardiovascular malformations and TRAPS. The chromosome karyotype of MCDA twins with structural malformations are sometimes discordant, and separate samling of the twins is suggested for prenatal diagnosis. Selective fetal reduction could be given to severe structural malformation in MCDA patients safely and effectively. For non-severe structural malformation in MCDA patients with twin transfusion syndrome, fetoscopic laser occlusion is safe and effective.

Perinatal outcomes and influencing factors following radiofrequency ablation in multiple pregnancies / 中华妇产科杂志

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.

Clinical application for pregnacy outcomes of radiofrequency ablation in complex multiple pregnancies / 中华妇产科杂志

Objective@#To investigate the safety and effectiveness of radiofrequency ablation (RFA) for selective fetal reduction in complex multiple pregnancies and analyze factors affecting perinatal outcomes.@*Methods@#This was a retrospective case series of 156 patients undergoing selective fetal reduction by RFA in Provincial Hospital Affiliated to Shandong University from July 22th, 2011 to September 12th, 2018. They were divided into five groups according to surgical indications, including 46 cases in the monochorionic twins discordant for fetal anomalies group, 42 cases in the multiple pregnancies for reducing fetal numbers group, 40 cases in the twin to twin transfusion syndrome (TTTS) group, 24 cases in the selective intrauterine growth restriction (sIUGR) group and 4 cases in the twin reversed arterial perfusion sequence (TRAPS) group. According to the gestational age at surgery, patients were divided into two groups: the gestational age at surgery <20 weeks group (75 cases) and the gestational age at surgery≥20 weeks group (81 cases). According to the cycles of RFA required for surgery, patients were divided into two groups: one cycle group (124 cases) and ≥2 cycles group (32 cases). Basic information of patients, surgical process, postoperative complications and pregnancy outcomes were recorded. The growth and development of survival newborns were also followed up. Factors affecting perinatal outcomes were analyzed.@*Results@#(1) The median gestational age at procedure of 156 patients was 20 weeks (14+5- 29+1 weeks). The median cycles of RFA was 1 cycle (1-3 cycles), of which one cycle accounted for 79.5% (124/156). (2) Eleven (7.1%, 11/156) patients experienced intrauterine fetal death, 27 (17.3%, 27/156) patients miscarried, and the overall survival rate was 75.6% (118/156). Premature birth rate before 34 weeks was 19.5% (23/118). There were 129 neonates. The median gestational age at delivery was 37+3 weeks (28+2- 41+1 weeks) with a mean birth weight of (2 657±700) g. (3) Analysis of pregnancy outcomes based on surgical indications found that, the gestational age at delivery [38 weeks (30+1-41+1 weeks), 36+4 weeks (29- 39 weeks), 36+4 weeks (28+2-39+5 weeks), 38 weeks (31-39+6 weeks), 38+3 weeks (30+4-38+4 weeks)] and neonatal birth weight [(2 820±671), (2 435±416), (2 497±843), (2 998±718), (2 517±1 087) g] were significantly different among fetal anomalies group, reducing fetal numbers group, TTTS group, sIUGR group and TRAPS group, respectively (all P<0.05). There were no significant differences in the pregnancy outcomes between gestational age at surgery <20 weeks group and gestational age at surgery ≥20 weeks group, or between one cycle group and ≥2 cycles group, respectively (all P>0.05).@*Conclusions@#RFA is a safe and effective procedure in treating complex monochorionic multiple pregnancies. Surgical indications would affect the gestational age at delivery and neonatal outcomes.

Safety of radiofrequency ablation for fetal reduction in monochorionic twin pregnancies over 26 weeks of gestation / 中华围产医学杂志

Objective To investigate the efficacy and safety of radiofrequency ablation for fetal reduction in monochorionic twin pregnancies at gestational age over 26 weeks. Methods A retrospective study was performed based on the clinical data of 51 patients who underwent fetal reduction by radiofrequency ablation in the First Affiliated Hospital of Chongqing Medical University from May 2013 to July 2018. Clinical data including basic information, surgical data (such as ablation duration, power and the number of cycles), perinatal complications and pregnancy outcomes were collected. Differences in pregnancy outcomes were compared between the group with gestational age >26 weeks (n=17, group A) and that ≤26 weeks (n=34, group B) using t-test, rank-sum test and Chi-square test or Fisher's exact test. Results (1) The indications of fetal reduction were malformation in one of the twins, twin-to-twin transfusion syndrome, twin reversed arterial perfusion sequence and selective intrauterine growth restriction [45.1% (23/51), 15.7% (8/51), 19.6% (10/51) and 19.6% (10/51)]. The differences in the proportion of different indications between group A and B were statistically significant [12/17, 1/17, 0/17, 4/17 vs 32.4% (11/34), 20.6% (7/34), 29.4% (10/34), 17.7% (6/34), P=0.009]. Those in the group A required longer operation duration than the group B [M(min-max), 20(7-40) vs 15(3-29) min, Z=2.550, P=0.011]. (2) The gestational age of the 51 patients was (23.7±4.7) weeks (15+1-32+6 weeks), the overall survival rate of the remaining fetuses was 86.3% (44/51) and the preterm birth rate was 50.0% (22/44). The gestational age at operation was (28.9±2.5) weeks (26+1-32+6 week) in group A and (21.1±3.1) weeks (15+1-25+2 weeks) in group B. The survival rate of the remaining fetuses and the preterm birth rate in group A were significantly higher than those in group B [17/17 vs 79.4% (27/34), P=0.046; 12/17 vs 37.0% (10/27), χ2=4.697, P=0.030]. Conclusions Fetal reduction at gestational age>26 weeks, of which the main surgical indication is malformation in one of the twins, may increase the risk of preterm birth, but can improve the overall survival rate of the remaining fetuses without increasing the maternal and infant morbidity. Therefore, radiofrequency ablation is a safe and effective procedure for twin pregnancies >26 weeks of gestation.

Monochorionic monoamniotic twins discordant for anencephaly: a case report / 中华围产医学杂志

We reported a case of monochorionic monoamniotic twins discordant for anencephaly diagnosed by second-trimester ultrasonography at the First Affiliated Hospital of Fujian Medical University.Ultrasound at seven weeks of gestation showed only one gestational sac with an embryo inside.Another 12 gestational weeks' ultrasound scan performed at another hospital found one gestational sac and one fetus (crown-rump length was 6.11 cm and nuchal translucency was 0.11 cm) in the upper-middle uterine cavity.The ultrasound examination at 22+6 gestational weeks identified one placenta and two fetuses without obvious diaphragm echo in between.Although no structural abnormality was observed in one fetus,frog-like eyes,absence of skull image and brain tissue echo were presented in the other fetus.The patient was transferred to a higher level hospital and was successfully performed radiofrequency ablation for selective reduction at 23+4 weeks of gestation.At 35 weeks,a premature live boy and an anencephalic stillbirth fetus were born vaginally after premature rupture of membranes.The baby boy was healthy at follow-up at four months old.

Safety of radiofrequency ablation for fetal reduction in monochorionic twin pregnancies over 26 weeks of gestation / 中华围产医学杂志

Objective@#To investigate the efficacy and safety of radiofrequency ablation for fetal reduction in monochorionic twin pregnancies at gestational age over 26 weeks.@*Methods@#A retrospective study was performed based on the clinical data of 51 patients who underwent fetal reduction by radiofrequency ablation in the First Affiliated Hospital of Chongqing Medical University from May 2013 to July 2018. Clinical data including basic information, surgical data (such as ablation duration, power and the number of cycles), perinatal complications and pregnancy outcomes were collected. Differences in pregnancy outcomes were compared between the group with gestational age >26 weeks (n=17, group A) and that ≤26 weeks (n=34, group B) using t-test, rank-sum test and Chi-square test or Fisher's exact test.@*Results@#(1) The indications of fetal reduction were malformation in one of the twins, twin-to-twin transfusion syndrome, twin reversed arterial perfusion sequence and selective intrauterine growth restriction [45.1% (23/51), 15.7% (8/51), 19.6% (10/51) and 19.6% (10/51)]. The differences in the proportion of different indications between group A and B were statistically significant [12/17, 1/17, 0/17, 4/17 vs 32.4% (11/34), 20.6% (7/34), 29.4% (10/34), 17.7% (6/34), P=0.009]. Those in the group A required longer operation duration than the group B [M(min-max), 20(7-40) vs 15(3-29) min, Z=2.550, P=0.011]. (2) The gestational age of the 51 patients was (23.7±4.7) weeks (15+1-32+6 weeks), the overall survival rate of the remaining fetuses was 86.3% (44/51) and the preterm birth rate was 50.0% (22/44). The gestational age at operation was (28.9±2.5) weeks (26+1-32+6 week) in group A and (21.1±3.1) weeks (15+1-25+2 weeks) in group B. The survival rate of the remaining fetuses and the preterm birth rate in group A were significantly higher than those in group B [17/17 vs 79.4% (27/34), P=0.046; 12/17 vs 37.0% (10/27), χ2=4.697, P=0.030].@*Conclusions@#Fetal reduction at gestational age >26 weeks, of which the main surgical indication is malformation in one of the twins, may increase the risk of preterm birth, but can improve the overall survival rate of the remaining fetuses without increasing the maternal and infant morbidity. Therefore, radiofrequency ablation is a safe and effective procedure for twin pregnancies >26 weeks of gestation.

Multifetal pregnancy reduction and application of ultrasound during operation / 中国介入影像与治疗学

The incidence of multiple pregnancies has increased significantly in recent years, which brought an adverse effect on pregnancy outcomes. Reducing fetuses of multiple pregnancies can improve the outcome of multiple births by reducing the number of fetuses in pregnancy and creating a better living environment for the remaining fetuses. Methods of multifetal pregnancy reduction and application of ultrasound during the operation were reviewed in this article.

Experience of Decision Making about Selective Fetal Reduction among Women Who Conceived through Assisted Reproductive Techniques / 임상간호연구

PURPOSE: This study aimed to explore and understand the experience of decision making among women undergoing or forgoing selective fetal reduction who have higher-order multiple pregnancies through assisted reproductive techniques. METHODS: A qualitative study was conducted from August 1, to October 30, 2013. Eight participants were interviewed and the interviews were audio-recorded and transcribed verbatim. Six persons participated in in-depth interviews in person and two participated over the telephone. A thematic analysis was conducted. RESULTS: Four themes were identified and carefully named: Confusion after higher-order multiple pregnancy; Obstacles to choice: Uncertain safety; Weighing between reality and ideality and; Influences of medical professionals. CONCLUSION: The results demonstrated a wide range of factors considered by women when making decisions about selective fetal reduction, and mothers'feelings of conflict and distress in the decision-making process. The results suggest that it is important for nurses to provide emotional support and consolation, in addition to sufficient information. These findings will help nurses improve their counseling techniques by understanding the situation of infertile couples.

Safety and efficacy of radiofrequency fetal ablation for monozygotic triplet and quadruplet pregnancies / 中华围产医学杂志

Objective To investigate the safety and efficacy of radiofrequency fetal ablation (RFA) in the treatment of monozygotic triplet and quadruplet pregnancies. Methods We analyzed retrospectively the clinical data of eight gravidas, including seven monozygotic triplets and one monozygotic quadruplets admitted to the Department of Obstetrics, Shandong Provincial Hospital Affiliated to Shandong University from March 2014 to January 2017. All of the eight women accepted ultrasound-guided selective fetal reduction by RFA to reduce to twins. Descriptive methods were used to analyze the perioperative status of the gravidas, maternal and fetal outcomes and neonatal follow-up. Results (1) In seven cases, the fetuses were deprived of blood flow after one heating cycle of radiofrequency ablation, while in the other, blood flow was stopped after two heating cycles. Heart beats of the reduced fetuses slowed down gradually after RFA, and stopped at 10, 20-25 and 40 minutes after operation in one, four and three cases, respectively. The conserved fetus showed normal heartbeats. (2) All patients accepted regular obstetrical examination after RFA. One was diagnosed with gestational diabetes mellitus at 26 weeks, and hospitalized for 4 d because of preterm labor at 30+6weeks. One women was hospitalized to receive a two-week tocolysis treatment one day after surgery, and diagnosed with severe preeclampsia at 35 weeks. One patient who had a fever six days after surgery and was hospitalized for antiinfection treatment progressed to inevitable abortion on the day of admission. The other five pregnant women had no abnormalities. (3) Except for one miscarriage, the rest seven cases all continued the pregnancy until delivery by cesarean, among which two with preterm premature rupture of membranes eventually delivered before term (35+1and 33 weeks), one with severe preeclampsia also preterm delivered (35+4weeks) and four term deliveries. Apgar scores at 1 and 5 minutes of all newborns were over 7. Three of the 14 newborns were hospitalized and recovered, including one pathological jaundice, one laryngeal stridor and one premature. The last follow-up in September 2018 of all 14 babies did not show any abnormalities. Conclusions RFA is a feasible treatment for monozygotic triplets and quadruplets.

Microwave ablation for selective feticide in complicated monochorionic twin pregnancies / 中华围产医学杂志

Objective To evaluate the feasibility,safety and short-term fetal outcome of ultrasoundguided percutaneous microwave ablation for selective feticide in complicated monochorionic twin pregnancies.Methods Twenty-two patients who underwent microwave ablation for selective fetal reduction in Peking University Third Hospital between July 2015 and June 2016 were retrospectively studied.Surgical complications,fetal outcomes and neural development at age of 60 days were recorded.One-way ANOVA,Mann-Whitney U test,Chi-square or Fisher's exact test was used for statistical analysis.Results Indications of the 22 patients for selective feticide included five cases of twin pregnancy with one anomalous fetus,five cases of severe twintwin transfusion syndrome (TTTS),three cases of twin reserved arterial perfusion (TRAP) and nine cases of selective intrauterine growth restriction (sIUGR).All surgeries were successful under regional anesthesia.Four pregnancies (18.2％,4/22) ended in miscarriage following surgery,three of which were caused by intrauterine fetal death (13.6％,3/22) and one by premature rupture of membranes before 26 weeks of gestation (4.5％,1/22).Totally,18 babies were born alive at an average gestational age of (35.5 4.2) weeks (26～40 weeks+2) and with an average birth weight of (2 380.778) g (800～3 430 g),and four of them were preterm infants less than 32 weeks of gestation.Except for one extremely low birth weight infant,whose gestational age was 26 weeks at birth and birth weight was 800 g,died two days after birth,17 infants were discharged alive,giving an neonatal survival rate of 17/18.The total fetal survival rate was 77.3％ (17/22).Polyhydramnios,placenta location,and position of the fetus being aborted showed no significant effect on miscarriage or fetal survival rate (all P＞0.05).No severe maternal complications occurred.No brain injuries were detected by imaging examination in 17 infants who were followed up to 60 days of age.Conclusions Ultrasound-guided percutaneous microwave ablation can be used for selective feticide in complicated monochorionic twin pregnancies.Further studies are needed to evaluate its effects on long-term fetal outcome.

Retrospective analysis of outcomes of selectively or spontaneously reduced multiple pregnancies out of 6917 in vitro fertilization-embryo transfer pregnancy cycles / 中华妇产科杂志

Objective To analyze the effects of fetal reduction in early pregnancy on obstetric and neonatal outcomes of spontaneously or selectively reduced multiple pregnancies produced by in vitro fertilization-embryo transfer (IVF-ET). Methods Retrospective study of 6917 clinical pregnancies from IVF-ET cycles, including 754 multiple pregnancies divided into two groups according to the remaining fetus number: reduced singleton group (n=599) and reduced twin group (n=155); and maternal and neonatal outcomes of two groups were compared to primary singleton group (n=3589) and primary twin group (n=2574). Results The rate of pregnancy complication [9.85%(59/599) versus 6.21%(223/3589)], preterm birth [19.37%(116/599) versus 10.73%(385/3589)], low birth weight [9.71%(56/577) versus 4.57%(152/3324)], perinatal death [0.69%(4/577) versus 0.12%(4/3324)] and malformation [2.95%(17/577) versus 1.02%(34/3324)] in reduced singleton group were significantly higher than those in primary singleton group (all P0.05). In reduced singleton group, birth defect rate was 2.95%, which was higher than those of the other three groups (P<0.05), in this group spontaneous pregnancy reduction accounted for 89.3%(535/599). Conclusions (1) The rate of pregnancy complication, preterm birth, low birth weight, perinatal death and malformation in reduced singleton group are still higher than primary singletons, suggesting embryo reduction only is a compensated method in multiple pregnancies. Limiting the number of embryos transferred is the essential solution. (2) The rate of birth defect in spontaneous pregnancy reduction group is higher, so prenatal examination should be reinforced in this group.

Selective feticide in management of complicated monochorionic twin pregnancies in second trimester / 中华围产医学杂志

Objective To compare the outcomes of selective feticide by umbilical cord ligation (UCL),bipolar cord coagulation (BCC) and radiofrequency ablation (RFA) in the treatment of complicated monochorionic twins.Methods We retrospectively analyzed all cases of complicated monochorionic twin pregnancies treated at Peking University Third Hospital from August 2008 to December 2014.The indications for surgery included severe twin-to-twin transfusion syndrome (TTTS),selective intrauterine growth restriction (sIUGR) (type Ⅱ and Ⅲ),twin reversed arterial perfusion sequence (TRAP) or discordant anomaly.One-way ANOVA,LSD t test,Mann-Whitney U test,Chi-square or Fisher's exact test were used for statistical analysis.Results (1) A total of 68 patients chose selective feticide by different techniques,including fetoscopic UCL (n=18,UCL group) and ultrasound-guided RFA (n=46,RFA group).The other four patients treated by bipolar cord coagulation (BCC) were excluded.The maternal age,proportion of assisted reproductive technology,indications,gestational age and mean birth weight all showed no differences between the two groups (P＞0.05).One case of anterior placenta was found in UCL group,fewer than in the RFA group (27 cases,36.9％)(x2=4.853).No fetal loss occurred within two weeks in UCL group,but there were seven cases (seven cases,15.2％) of earlier fetal loss in RFA group (x2=4.952).The median operation time was (63.2±22.5) min in UCL group,and longer than in the RFA group (33.3 ± 11.4) min (t=5.165),all P＜0.05.(2) The gestational age of TTTS and TRAP patients for feticide was older than patients with sIUGR and discordant anomaly [(22.7± 3.0),(22.8±3.2),(20.3 ± 2.5) and (20.4± 3.6) weeks,respectively,F=2.957,P=0.040].Fetal loss rate within two weeks in patients with discordant anomaly was higher than in other groups (4/11 vs 1/10,0/23 and 1/15,P＜0.05).The survival rate,gestational age at delivery and mean birth weight showed no significant differences among the four groups.(3)Compared with feticided fetuses at the upper uterine cavity,the fetal loss rate was higher,and the operation time,gestational age at delivery,birth weight and neonatal survival rate were lower than those performed at the lower uterine cavity,but the difference was not significant.Conclusions RFA provides similar outcomes of selective feticide in complicated monochorionic twins compared with UCL,while RFA is easier to operate.

Pregnancy outcomes and nursing of 204 cases of multiple pregnancies undergoing transvaginal multifetal pregnancy reduction / 现代临床护理

Objective To analyze the pregnancy outcomes of 204 cases of multiple pregnancies following early transvaginal fetal reduction and sum up the experiences of peri-operation nursing care. Methods A total number of 204 twin and triplet pregnancies under treatment in the reproductive medical center from Jan. 2009 to Dec. 2012 were involved in the study. All patients underwent transvaginal multifetal pregnancy reduction during pregnancy of 7 to 8 weeks . The pregnancy outcomes were analyzed , and the nursing measures including preoperative preparation , intraoperative cooperation and postoperative nursing were analyzed . Result The successful rate of multifetal reduction was 100%, and the rate for taking the infants home reached 77.0% ~ 92.3%. Conclusion The outcomes of multifetal reduction for the twin or triplet pregnancy are good . Such nursing measures as perioperative mental care , intraoperative cooperation and postoperative follow-up are key to the alleviation of mental pressure during operation , raise of the success rate of fetal reduction and prevention of postoperative complications.

Ethical Consideration about Assisted Reproductive Technology Implementation / 中国医学伦理学

Through ethical analysis of the conflicts appearing in four special cases in the four steps of assisted reproductive technology implementations, this paper pointed out the measures to solve them in the perspective of le-gal protection, standardized management, ethical supervision, and self-regulation for making the research and ap-plication of assisted reproductive technology serve patients better and promoting the healthy development of assisted reproductive technology.

Radiofrequency ablation and bipolar umbilical cord coagulation for complicated monochorionic twins / 中华围产医学杂志

Objective To assess the effects of radiofrequency ablation (RFA) and bipolar cord coagulation (BCC) on the prognosis and complication rate of complicated monochorionic twins.Methods A retrospective review was undertaken in 58 cases of complicated monochorionic twins treated with RFA or BCC at the First Affiliated Hospital of Sun Yat Sen University,from January 2008 to August 2013.Non-parametric Wilcoxon test,Chi-square test,Fisher exact test or multi-variant Logistic regression analysis were used for statistical analysis.Results Indications for selective termination in the 58 cases were:twin reversed arterial perfusion sequence in 12,severe twin to twin transfusion syndrome in 28,discordance of fetal anomalies in 10,selective intrauterine growth restriction in 7 and twin anemia-polycythemia sequence in 1.Forty-three cases were managed with BCC and 15 with RFA.Preterm labor was more common in the BCC group than in the RFA group [86.0％(37/43) vs 9/15,respectively; x2=4.598,P=0.032).Premature rupture of the membranes occurred in 48.8％(27/43) of the BCC group vs.4/15 of the RFA group (x2=2.229,P=0.135).The median procedure-todelivery time was 48 (1-150) days for the BCC group vs.101(14-138) days for the RFA group (Z=-2.245,P=0.025).Overall survival rate was 62.8％(27/43) in the BCC group vs 11/15 in the RFA group (x2=0.547,P=0.460),which was not significantly different.Neurodevelopmental delay was detected in two neonates in BCC group and in one neonate in RFA group.Logistic regression analysis showed that delivery before 28 gestational weeks was an independent risk factor for the poor prognosis of the co-twins (OR=192.720,95％CI:18.610-994.000,P ＜ 0.01).Conclusion Compared with BCC,RFA does not improve the prognosis of complicated monochorionic twins significantly.