{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T23:59:18Z","timestamp":1768262358955,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Radiofrequency ablation (RFA) is the preferred approach for selective reduction in complex monochorionic (MC) multiple pregnancies owing to the ease of operation and minimal invasiveness. To optimize the RFA technique and reduce the risk of adverse pregnancy outcome resulting from the heat\u2010sink effect of RFA therapy, we used an innovative RFA method, in which an electrode needle was expanded incrementally and stepwise. This study aimed to assess the efficacy and safety profile of this novel multistep incremental expansion RFA method for selective fetal reduction in MC twin and triplet pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010center retrospective cohort study of all MC multiple pregnancies undergoing RFA between March 2016 and October 2022 at our center. The multistep RFA technique involved the use of an expandable needle, which was gradually expanded during the RFA procedure until cessation of umbilical cord blood flow was achieved. The needle used for the single\u2010step RFA method was fully extended from the start of treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 132 MC multiple pregnancies underwent selective reduction using RFA, including 50 cases undergoing multistep RFA and 82 cases undergoing single\u2010step RFA. The overall survival rates were not significantly different between the multistep and single\u2010step RFA groups (81.1% <jats:italic>vs<\/jats:italic> 72.3%; <jats:italic>P<\/jats:italic>\u2009=\u20090.234). Similarly, the rates of preterm prelabor rupture of the membranes within 2\u2009weeks after RFA, procedure\u2010related complications, spontaneous preterm delivery and pathological findings on cranial ultrasound, as well as gestational age at delivery and birth weight, did not differ between the two groups. However, there was a trend towards a prolonged procedure\u2010to\u2010delivery interval following multistep RFA compared with single\u2010step RFA (median, 109 <jats:italic>vs<\/jats:italic> 99\u2009days; <jats:italic>P<\/jats:italic>\u2009=\u20090.377). Moreover, the fetal loss rate within 2\u2009weeks after RFA in the multistep RFA group was significantly lower than that in the single\u2010step RFA group (10.0% <jats:italic>vs<\/jats:italic> 24.4%; <jats:italic>P<\/jats:italic>\u2009=\u20090.041). The median ablation time was shorter (5.3 <jats:italic>vs<\/jats:italic> 7.8 min; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and the median ablation energy was lower (10.2 <jats:italic>vs<\/jats:italic> 18.0 kJ; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) in multistep compared with single\u2010step RFA. There were no significant differences in neonatal outcomes following multistep <jats:italic>vs<\/jats:italic> single\u2010step RFA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall survival rates were similar between the two RFA methods. However, the multistep RFA technique was associated with a lower risk of fetal loss within 2\u2009weeks after RFA. The multistep RFA technique required significantly less ablation energy and a shorter ablation time compared with single\u2010step RFA in selective fetal reduction of MC twin and triplet pregnancies. Additionally, there was a trend towards a prolonged procedure\u2010to\u2010delivery interval with the multistep RFA technique. \u00a9 2023 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.27508","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T08:44:52Z","timestamp":1695890692000},"page":"522-528","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique"],"prefix":"10.1002","volume":"63","author":[{"given":"Y.\u2010H.","family":"Zhang","sequence":"first","affiliation":[{"name":"Zhejiang University School of Medicine, Women's Hospital  Hangzhou Zhejiang People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Jiao'e","sequence":"additional","affiliation":[{"name":"Zhejiang University School of Medicine, Women's Hospital  Hangzhou Zhejiang People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Chen","sequence":"additional","affiliation":[{"name":"Zhejiang University School of Medicine, Women's Hospital  Hangzhou Zhejiang People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.\u2010X.","family":"Zhou","sequence":"additional","affiliation":[{"name":"Zhejiang University School of Medicine, Women's Hospital  Hangzhou Zhejiang People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Zhan","sequence":"additional","affiliation":[{"name":"Zhejiang University School of Medicine, Women's Hospital  Hangzhou Zhejiang People's Republic 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