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Introduction <p>Monochorionic twin pregnancies are associated with significant risks such as fetal growth restriction, twin-to-twin transfusion syndrome (TTTS), preterm delivery, and increased perinatal mortality. TTTS, resulting from abnormal placental vascular anastomoses, can lead to severe complications such as brain injury or death if left untreated. Traditional interventions for TTTS include amnioreduction, laser ablation, and selective fetal termination. However, in severe cases, particularly when other methods fail, radiofrequency ablation (RFA) has emerged as an effective alternative. RFA uses high-frequency alternating current to coagulate tissue, selectively reducing the twin with a poorer prognosis.</p> Case Details <p>This case report discusses a 25-year-old woman at 28&#xa0;weeks of gestation with a monochorionic twin pregnancy complicated by stage III TTTS. Despite amnioreduction, the condition worsened. Selective fetal reduction in the donor twin by RFA was performed. Following the procedure, the surviving twin’s prognosis improved. The patient delivered a healthy baby at 36&#xa0;weeks by elective cesarean section, with the selectively reduced fetus delivered afterward. At the 3-year follow-up, the child remained healthy with normal growth and neurodevelopmental milestones.</p> Discussion <p>This case highlights that when patients are selected appropriately, RFA offers a high success rate, both short-term and at three-year follow-up. Fetoscopic laser coagulation was not attempted as it was stage III TTTS and the optimum window (16–26&#xa0;weeks) had been crossed. Elective delivery by LSCS was not attempted because of extreme prematurity. As the pregnancy had crossed 16&#xa0;weeks, interstitial laser was also not attempted for selective termination. This case highlights the importance of counseling before selective reduction in TTTS at 28&#xa0;weeks versus elective delivery. Normal developmental milestones of the baby highlight the importance of the right intervention at the right time. The baby is being followed for further developmental milestones.</p>

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Radiofrequency Ablation in Twin-to-Twin Transfusion Syndrome with Three-year Follow-up

  • 期刊论文

  • 发表日期：

    2026年4月30日

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  • Avishek Bhadra,
  • Kusagradhi Ghosh,
  • Debjani Bhadra,
  • Seetha Ramamurthy Pal,
  • Rumela Biswas

摘要

Introduction

Monochorionic twin pregnancies are associated with significant risks such as fetal growth restriction, twin-to-twin transfusion syndrome (TTTS), preterm delivery, and increased perinatal mortality. TTTS, resulting from abnormal placental vascular anastomoses, can lead to severe complications such as brain injury or death if left untreated. Traditional interventions for TTTS include amnioreduction, laser ablation, and selective fetal termination. However, in severe cases, particularly when other methods fail, radiofrequency ablation (RFA) has emerged as an effective alternative. RFA uses high-frequency alternating current to coagulate tissue, selectively reducing the twin with a poorer prognosis.

Case Details

This case report discusses a 25-year-old woman at 28 weeks of gestation with a monochorionic twin pregnancy complicated by stage III TTTS. Despite amnioreduction, the condition worsened. Selective fetal reduction in the donor twin by RFA was performed. Following the procedure, the surviving twin’s prognosis improved. The patient delivered a healthy baby at 36 weeks by elective cesarean section, with the selectively reduced fetus delivered afterward. At the 3-year follow-up, the child remained healthy with normal growth and neurodevelopmental milestones.

Discussion

This case highlights that when patients are selected appropriately, RFA offers a high success rate, both short-term and at three-year follow-up. Fetoscopic laser coagulation was not attempted as it was stage III TTTS and the optimum window (16–26 weeks) had been crossed. Elective delivery by LSCS was not attempted because of extreme prematurity. As the pregnancy had crossed 16 weeks, interstitial laser was also not attempted for selective termination. This case highlights the importance of counseling before selective reduction in TTTS at 28 weeks versus elective delivery. Normal developmental milestones of the baby highlight the importance of the right intervention at the right time. The baby is being followed for further developmental milestones.