Radiofrequency Ablation of Umbilical Cord for Reduction of Twin Reversed Arterial Perfusion Sequence: A Case Series and a Literature Review

Objective: To evaluate the outcome of radiofrequency ablation of the umbilical cord in the reduction of Twin Reversed Arterial Perfusion (TRAP) sequence or acardiac twin in monochorionic diamniotic pregnancies. Material and methods: In this prospective study, 25 cases of monochorionic diamniotic pregnancy with one acardiac twin underwent selected reduction using radiofrequency ablation (RFA) in the second trimester of gestational age, from 2018 to 2019 in a tertiary referral hospital affiliated to Tehran University of Medical Sciences. Results: The overall survival rate was 84%. The mean±SD of gestational age at the time of the procedure and delivery were 20.0±3.8 and 35w±6.0 days respectively. Nine neonates were admitted to the neonatal intensive care unit (NICU) and 4 miscarriages were recorded in less than 24 weeks. The procedures in all cases were technically successful in achieving selective termination. Conclusion: Radiofrequency ablation for fetal reduction in acardiac twins in monochorionic pregnancies appears to be a safe and reasonable option.