Microwave ablation for selective fetal reduction in complicated monochorionic diamniotic twin pregnancies: Experience from a single tertiary center.

OBJECTIVE

To investigate the use of microwave ablation (MWA) for selective fetal reduction in monochorionic twin pregnancies.

METHODS

This retrospective, single-center case series included consecutive monochorionic diamniotic twin pregnancies that underwent selective fetal reduction using MWA at a tertiary fetal medicine center between October 2023 and December 2025. Indications included severe twin-to-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), twin reversed arterial perfusion (TRAP) sequence, and major fetal anomalies. Procedural, pregnancy, and neonatal parameters were analyzed descriptively. No formal between-group comparisons were performed because of the small subgroup sizes.

RESULTS

Fifteen consecutive procedures were performed at a median gestational age of 20+1 weeks. Technical success was achieved in all cases. All 15 pregnancies resulted in live birth of the surviving co-twin. The median gestational age at delivery was 38+0 weeks, with a median procedure-to-delivery interval of 17+2 weeks. Preterm premature rupture of membranes occurred in one case. Four neonates required admission to the neonatal intensive care unit, and no neonatal deaths occurred.

CONCLUSION

MWA was technically feasible in this small single-center case series. However, the limited sample size and heterogeneous clinical indications preclude indication-specific or comparative conclusions. Larger multicenter studies with standardized outcome reporting and long-term follow up are required.