Perinatal outcomes after radiofrequency ablation for selective fetal reduction in complicated monochorionic pregnancies: a single-center experience

Monochorionic (MC) pregnancies are often complicated by shared placental and circulatory structures, resulting in conditions such as twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), and a twin-reversed arterial perfusion (TRAP) sequence. This study aimed to evaluate perinatal outcomes following radiofrequency ablation (RFA) for selective fetal reduction in complicated MC pregnancies at a tertiary care center in India. This retrospective cohort study analyzed 100 MC pregnancies that underwent RFA for selective fetal reduction between January 2016 and December 2023. The indications included TTTS, sFGR (stages II and III), discordant anomalies, TRAP, and elective reduction. The key outcomes assessed were live birth rates, procedural success, and complications, including preterm prelabor rupture of membranes (PPROM) and co-twin survival. Data were compared between the two intervention periods to evaluate improvements over time. Procedural success was achieved in all patients with no intraoperative complications. The median gestational age at the time of the procedure was 22 weeks. The overall live birth rate was 85%, and the discharge survival rate was 79%. PPROM occurred in 18% of patients, whereas fetal death was observed in 15%, predominantly in patients with TTTS. Post-procedure magnetic resonance imaging detected cerebral injury in 2% of surviving twins. Logistic regression analysis did not identify any significant predictors of co-twin death. RFA is an effective technique for selective fetal reduction in MC pregnancies, offering favorable survival outcomes, even in a resource-limited setting. Further research should focus on refining patient selection and procedure timing, especially for high-risk groups such as those with TTTS, to enhance survival and long-term outcomes in developing countries.