Introduction: The aim of this study was to assess the short- and long-term outcome of selective reduction by fetoscopy-guided bipolar cord coagulation in monochronic twin pregnancies. Methods: Retrospective analysis was conducted of a consecutive cohort of all monochorionic twin pregnancies treated with fetoscopy-guided bipolar cord coagulation between December 2015 and December 2022 in a single center in China. Results: A total of 43 monochronic twin pregnancies undergoing fetoscopy-guided bipolar cord coagulation were analyzed. There were 5 intrauterine deaths with an 88.4% (38/43) survival rate overall. The preterm premature rupture of the membranes rate was 13.2%, and the preterm birth before 37 and 32 weeks was 42.1% and 13.1%, respectively. An uptrend in the survival rate (78.9 vs. 95.8%, p = 0.086) and a downtrend of procedure time (30 vs. 16.5 min, p = 0.036) were observed over time (period 1 from December 2015 to December 2019 verses period 2 from January 2020 to December 2022). Long-term outcome was assessed in 94.6% (35/37) of survivors, and 91.4% (32/35) had normal neurodevelopmental outcome. Conclusion: Fetoscopy-guided bipolar cord coagulation for fetal reduction in complicated monochorionic twin pregnancies could achieve a favorable short- and long-term outcome, especially in experienced hands.

1.
Emery
SP
,
Bahtiyar
MO
,
Moise
KJ
;
North American Fetal Therapy Network
.
The North American fetal therapy network consensus statement: management of complicated monochorionic gestations
.
Obstet Gynecol
.
2015
;
126
(
3
):
575
84
.
2.
Bebbington
M
.
Selective reduction in complex monochorionic gestations
.
Am J Perinatol
.
2014
;
31
(
Suppl 1
):
S51
8
.
3.
Ong
SS
,
Zamora
J
,
Khan
KS
,
Kilby
MD
.
Prognosis for the co-twin following single-twin death: a systematic review
.
BJOG
.
2006
;
113
(
9
):
992
8
.
4.
Donepudi
R
,
Hessami
K
,
Nassr
AA
,
Espinoza
J
,
Sanz Cortes
M
,
Sun
L
, et al
.
Selective reduction in complicated monochorionic pregnancies: a systematic review and meta-analysis of different techniques
.
Am J Obstet Gynecol
.
2022
;
226
(
5
):
646
55.e3
.
5.
Gaerty
K
,
Greer
RM
,
Kumar
S
.
Systematic review and metaanalysis of perinatal outcomes after radiofrequency ablation and bipolar cord occlusion in monochorionic pregnancies
.
Am J Obstet Gynecol
.
2015
;
213
(
5
):
637
43
.
6.
Yamamoto
M
,
Barki
G
,
Ville
Y
.
Direct visual control on cord coagulation using a fetoscopy-guided bipolar forceps: description of a new technique
.
Prenat Diagn
.
2010
;
30
(
2
):
156
8
.
7.
Weber
EC
,
Strizek
B
,
Recker
F
,
Geipel
A
,
Gembruch
U
,
Berg
C
, et al
.
Outcome of monochorionic pregnancies after selective feticide with bipolar cord coagulation: a German single center experience
.
J Clin Med
.
2022
;
11
(
6
):
1516
.
8.
Tang
HR
,
Dai
CY
,
Li
J
,
Dai
YM
,
Ru
T
,
Li
YL
, et al
.
Fetoscopy-guided bipolar cord coagulation in selective fetal reduction with complicated monochorionic diamniotic twins: a prospective cohort study
.
J Matern Fetal Neonatal Med
.
2022
;
35
(
25
):
7744
7
.
9.
Khalil
A
,
Rodgers
M
,
Baschat
A
,
Bhide
A
,
Gratacos
E
,
Hecher
K
, et al
.
ISUOG Practice Guidelines: role of ultrasound in twin pregnancy
.
Ultrasound Obstet Gynecol
.
2016
;
47
(
2
):
247
63
.
10.
Wu
T
,
Chen
Z
,
Yin
X
,
Shi
H
,
Niu
J
,
Xie
J
, et al
.
Perinatal outcomes after selective feticide via umbilical cord occlusion in complicated monochorionic pregnancies: a systematic review and meta-analysis
.
Prenat Diagn
.
2022
;
42
(
1
):
37
48
.
11.
Shinar
S
,
Agrawal
S
,
El-Chaâr
D
,
Abbasi
N
,
Beecroft
R
,
Kachura
J
, et al
.
Selective fetal reduction in complicated monochorionic twin pregnancies: a comparison of techniques
.
Prenat Diagn
.
2021
;
41
(
1
):
52
60
.
12.
Sugibayashi
R
,
Ozawa
K
,
Sumie
M
,
Wada
S
,
Ito
Y
,
Sago
H
.
Forty cases of twin reversed arterial perfusion sequence treated with radio frequency ablation using the multistep coagulation method: a single-center experience
.
Prenat Diagn
.
2016
;
36
(
5
):
437
43
.
13.
Kumar
S
,
Paramasivam
G
,
Zhang
E
,
Jones
B
,
Noori
M
,
Prior
T
, et al
.
Perinatal- and procedure-related outcomes following radiofrequency ablation in monochorionic pregnancy
.
Am J Obstet Gynecol
.
2014
;
210
(
5
):
454.e1
454.e4546
.
14.
van den Bos
EM
,
van Klink
JM
,
Middeldorp
JM
,
Klumper
FJ
,
Oepkes
D
,
Lopriore
E
.
Perinatal outcome after selective feticide in monochorionic twin pregnancies
.
Ultrasound Obstet Gynecol
.
2013
;
41
(
6
):
653
8
.
15.
Bebbington
MW
,
Danzer
E
,
Moldenhauer
J
,
Khalek
N
,
Johnson
MP
.
Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies
.
Ultrasound Obstet Gynecol
.
2012
;
40
(
3
):
319
24
.
16.
Schou
KV
,
Jensen
LN
,
Jørgensen
C
,
Søgaard
K
,
Tabor
A
,
Sundberg
K
.
Ultrasound-guided bipolar umbilical cord occlusion in complicated monochorionic pregnancies: is there a learning curve
.
Fetal Diagn Ther
.
2018
;
44
(
1
):
65
71
.
17.
Lanna
MM
,
Rustico
MA
,
Dell’Avanzo
M
,
Schena
V
,
Faiola
S
,
Consonni
D
, et al
.
Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center
.
Ultrasound Obstet Gynecol
.
2012
;
39
(
4
):
407
13
.
18.
Robyr
R
,
Yamamoto
M
,
Ville
Y
.
Selective feticide in complicated monochorionic twin pregnancies using ultrasound-guided bipolar cord coagulation
.
BJOG
.
2005
;
112
(
10
):
1344
8
.
19.
Lewi
L
,
Gratacos
E
,
Ortibus
E
,
Van Schoubroeck
D
,
Carreras
E
,
Higueras
T
, et al
.
Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies
.
Am J Obstet Gynecol
.
2006
;
194
(
3
):
782
9
.
20.
Delabaere
A
,
Favre
N
,
Velemir
L
,
Bentaoui
S
,
Coste
K
,
Laurichesse- Demas
H
, et al
.
Pediatric outcome after selective feticide for 30 complicated monochorionic twin pregnancies
.
Gynecol Obstet Fertil
.
2013
;
41
(
2
):
85
9
.
21.
van Klink
J
,
Koopman
HM
,
Middeldorp
JM
,
Klumper
FJ
,
Rijken
M
,
Oepkes
D
, et al
.
Long-term neurodevelopmental outcome after selective feticide in monochorionic pregnancies
.
BJOG
.
2015
;
122
(
11
):
1517
24
.
22.
Wu
T
,
Gong
X
,
Wang
X
,
Li
L
,
Chen
Z
,
Yuan
P
, et al
.
Perinatal and neurodevelopmental outcome in complicated monochorionic pregnancy after selective fetal reduction: radiofrequency ablation vs microwave ablation
.
Ultrasound Obstet Gynecol
.
2022
;
60
(
4
):
506
13
.
23.
Rahimi-Sharbaf
F
,
Ghaemi
M
,
Nassr
AA
,
Shamshirsaz
AA
,
Shirazi
M
.
Radiofrequency ablation for selective fetal reduction in complicated Monochorionic twins; comparing the outcomes according to the indications
.
BMC Pregnancy Childbirth
.
2021
;
21
(
1
):
189
.
You do not currently have access to this content.