Selective reduction in complicated monochorionic pregnancies: radiofrequency ablation vs. bipolar cord coagulation

Objective: To compare radiofrequency ablation (RFA) and bipolar cord coagulation (BPC) methods for selective fetal reduction in the treatment of complicated monochorionic (MC) multifetal gestations.

Methods: This was a retrospective review of patients who underwent selective reduction by RFA and BPC. Computer-generated random sampling was performed to match patients who had undergone BPC with patients who had undergone RFA, in a 2 : 1 ratio, controlling for gestational age and indication. The primary outcome was fetal survival.

Results: Twenty patients in the RFA group were matched with 40 patients in the BPC group. Fewer additional intra-operative procedures were performed in the RFA group compared with the BPC group: amnioinfusion, 10% vs. 75%, respectively (P < 0.01); and amnioreduction, 5% vs. 40%, respectively (P = 0.004). The overall survival rates were 87.5% in the RFA group and 88% in the BPC group (P = 0.94). Median gestational age at delivery was 36 (range, 26-41) weeks in the RFA group and 39 (range, 19-40) weeks in the BPC group (P = 0.59). Preterm delivery (at < 28, < 32 or < 37 weeks), weeks gained after the procedure and birth weight at delivery were also similar. Although the preterm premature rupture of membranes (PPROM) rate was higher in the BPC group (22.5%) compared with the RFA group (5%), the difference was not statistically significant (P = 0.09).

Conclusions: Overall fetal survival rate following selective reduction in complicated MC pregnancies is similar whether reduction is performed by RFA or BPC. Fewer additional intraoperative procedures are required for RFA than for BPC. The possibility that RFA is associated with a lower rate of postoperative PPROM than is BPC will have to be confirmed in larger series.