{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:14:53Z","timestamp":1789755293371,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate whether gestational age at intervention (&lt; or \u2265\u200916\u2009weeks) and other factors affect the risk of loss of the cotwin after selective fetal reduction using radiofrequency ablation (RFA) in monochorionic (MC) pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010center retrospective analysis of 63 consecutive RFA procedures performed at our institution from January 2011 to October 2019 for selective fetal reduction in complicated MC pregnancies. Indications for RFA were twin reversed arterial perfusion sequence (13 cases), twin\u2010to\u2010twin transfusion syndrome (12 cases), twin anemia\u2013polycythemia sequence (two cases), selective fetal growth restriction (10 cases), discordant anomalies (17 cases) and multifetal pregnancy reduction in triplets or quadruplets with a MC pair (nine cases). Twenty\u2010six (41.3%) of these procedures were performed before and 37 (58.7%) after 16\u2009weeks. Potential factors that could affect the risk of loss of the cotwin, including gestational age at RFA, order of multiple pregnancy, amnionicity, indication for RFA and number of ablation cycles, were assessed first by univariate analysis and then by multivariate analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 17 (27.0%) cotwin losses. Ablation cycles numbering four or more was the only factor among those investigated to be associated with loss of the cotwin after RFA (<jats:italic>P<\/jats:italic>\u2009=\u20090.035; odds ratio, 5.21), while the indication for RFA, order of multiple pregnancy, amnionicity and gestational age at RFA had no effect. Comparing RFA performed at &lt;\u200916 <jats:italic>vs<\/jats:italic> \u2265\u200916\u2009weeks, there was no difference in the rate of cotwin loss (23.1% <jats:italic>vs<\/jats:italic> 29.7%; <jats:italic>P<\/jats:italic>\u2009=\u20090.558) or preterm prelabor rupture of the membranes before 34\u2009weeks (7.7% <jats:italic>vs<\/jats:italic> 5.4%; <jats:italic>P<\/jats:italic>\u2009=\u20090.853), or in the median gestational age at delivery (36.2\u2009<jats:italic>vs<\/jats:italic>\u200937.3\u2009weeks; <jats:italic>P<\/jats:italic>\u2009=\u20090.706).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>RFA is a promising tool for early selective fetal reduction in MC pregnancy before 16\u2009weeks. Four or more ablation cycles is a major risk factor for cotwin loss. Careful assessment pre\u2010 and post\u2010RFA, together with proficient operative skills to minimize the number of ablation cycles, are the mainstay to ensure that this procedure is effective and safe. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22160","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T04:01:29Z","timestamp":1596168089000},"page":"214-220","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Outcome of radiofrequency ablation for selective fetal reduction before <i>vs<\/i> at or after 16\u2009gestational weeks  in complicated monochorionic pregnancy"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5115-3977","authenticated-orcid":false,"given":"Y. H.","family":"Ting","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3944-4130","authenticated-orcid":false,"given":"L. C. Y.","family":"Poon","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. T.","family":"Tse","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Y.","family":"Chung","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y. M.","family":"Wah","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. S. Y.","family":"Hui","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. M.","family":"Law","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5398-6868","authenticated-orcid":false,"given":"P.","family":"Chaemsaithong","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9153-0343","authenticated-orcid":false,"given":"T. Y.","family":"Leung","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital The Chinese University of Hong Kong  Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,6]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"1431","article-title":"Treatment of twin\u2010twin transfusion syndrome by fetoscopic laser photocoagulation","volume":"117","author":"Lau TK","year":"2004","journal-title":"Chin Med J (Engl)"},{"key":"e_1_2_7_3_1","first-page":"275","article-title":"Fetoscopic laser photocoagulation in the management of twin\u2010twin transfusion syndrome: local experience from Hong Kong","volume":"16","author":"Yang X","year":"2010","journal-title":"Hong Kong Med J"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2011.573830"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22042"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.04.018"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1999.13060392.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000358593"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)91769-8"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)02449-5"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)12346-7"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12495"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18834"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.16013"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20860"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.08.039"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.02.010"},{"key":"e_1_2_7_18_1","first-page":"326","article-title":"Triplet pregnancy with fetal reduction: experience in Hong Kong","volume":"23","author":"Tse WT","year":"2017","journal-title":"Hong Kong Med J"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000355406"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5269"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5196"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000368601"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.12.009"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.22160","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.22160","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.22160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T03:58:43Z","timestamp":1693195123000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.22160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,6]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1002\/uog.22160"],"URL":"https:\/\/doi.org\/10.1002\/uog.22160","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,6]]},"assertion":[{"value":"2020-05-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}