Learning curve for the perinatal outcomes of radiofrequency ablation for selective fetal reduction: a single-center, 10-year experience from 2013 to 2023.

Objectives: To investigate the perinatal outcomes of SR using radiofrequency ablation (RFA) in MC pregnancies, identified factors affecting these outcomes, and assessed the associated learning curve.

Methods: This retrospective cohort study included all consecutive MC pregnancies that required RFA from September 2013 to April 2023 at our institution. The perinatal outcomes were compared on the basis of various indications, and binary logistic regression analysis was performed to identify the risk factors for cotwin loss. Clinical datas of two periods (2013-2018 vs. 2019-2023) were compared to demonstrate the learning curve.

Results: The 107 cases composed of 40 (37.4 %) twin-twin transfusion syndrome (TTTS), 17 (15.9 %) selective intrauterine growth restriction (sFGR), 12 (11.2 %) twin reversed arterial perfusion sequence (TRAPS), 25 (23.4 %) fetal discordant anomalies, 10 (9.3 %) elective fetal reduction (EFR), and three (2.8 %) twin anemia polycythemia sequence (TAPS) cases. The overall live birth rate for cotwins was 83.2 %. The earliest gestational age at delivery was noted in the TTTS group (p=0.021). The procedure-to-delivery interval was the shortest in the TTTS group and the longest in the EFR group (p<0.001). Comparing the 2013-2018 period with the 2019-2023 period, we noted a significant increase in the live birth rate (p=0.01) and the procedure-to-delivery interval (p=0.003), mainly due to improved outcomes in TTTS cases.

Conclusions: RFA for SR is a safe and effective method for managing complicated MC pregnancies. The type of indication affects postoperative perinatal outcomes, with TTTS showing the most adverse effects. With the increasing number of cases and accumulation of experiences with simultaneous enhancement of technique proficiency, the postprocedural outcomes can be further improved.