A Comparison of Perinatal and Neonatal Outcomes between Complicated Monochorionic Triamniotic and Dichorionic Triamniotic Pregnancies after Selective Fetal Reduction by Radiofrequency Ablation

Background: Triplet pregnancies are associated with significant perinatal and neonatal morbidity and mortality, often necessitating selective fetal reduction (SFR) to improve outcomes. This study compares perinatal and neonatal outcomes between complicated monochorionic triamniotic (MC-TA) and dichorionic triamniotic (DC-TA) triplet pregnancies undergoing selective fetal reduction using radiofrequency ablation (RFA). Methods: This retrospective cohort study, conducted at Yas Hospital, Tehran, Iran, from March ۲۰۱۷ to March ۲۰۲۴, included all complicated MC-TA and DC-TA triplet pregnancies undergoing RFA between ۱۶ and ۲۶ weeks’ gestation. Outcomes included live birth rate, miscarriage rate, gestational age at delivery, and neonatal metrics (birth weight, Apgar scores, and neonatal intensive care unit [NICU] admission). Data were analyzed using SPSS version ۲۴.۰, with statistical significance set at p < ۰.۰۵. Results: Of ۳۲ triplet pregnancies (۲۰ DC-TA and ۱۲ MC-TA), the mean gestational age at RFA was significantly lower in MC-TA (۱۹.۵۸ ± ۱.۸ weeks) than in DC-TA (۲۲.۳ ± ۲.۱ weeks; p = ۰.۰۰۵). Twin-to-twin transfusion syndrome (TTTS) was the primary indication for MC-TA (۵۰%), while selective fetal growth restriction (FGR) predominated in DC-TA (۴۵%). The overall pregnancy survival rate was ۷۸.۱%, with live birth rates of ۷۰% in MC-TA and ۷۴.۳% in DC-TA (p = ۰.۷۲). Miscarriage rates were ۲۵% in MC-TA and ۲۰% in DC-TA (p = ۰.۶۸). Mean gestational age at delivery (MC-TA: ۳۵.۱ ± ۲.۳ weeks; DC-TA: ۳۴.۴ ± ۳.۰ weeks; p = ۰.۵۱) and neonatal outcomes (birth weight, Apgar scores, and NICU admission) were comparable. Conclusion: RFA is an effective intervention for selective fetal reduction in complicated triplet pregnancies, yielding a ۷۸.۱% pregnancy survival rate with no significant differences in perinatal or neonatal outcomes between MC-TA and DC-TA groups. RFA is recommended as a safe, minimally invasive option, with post-procedure ultrasound monitoring advised to mitigate complications.

کلیدواژه ها:

Dichorionic triamniotic ، Monochorionic triamniotic ، Neonatal Outcomes ، Perinatal outcomes ، Radiofrequency Ablation ، Selective fetal reduction