(1056) Selective reduction in pregnancies with selective fetal growth restriction: systematic review and meta-analysis of outcomes

Objective:
To estimate the rates of co-twin intrauterine demise (IUFD), co-twin neonatal demise and gestational age (GA) at delivery in monochorionic (MC) pregnancies complicated by selective fetal growth restriction (sFGR) undergoing selective reduction (SR), and stratify the outcomes according to the surgical technique.

Study Design:
We searched PubMed, Scopus, and Web of Science from inception through May 2025. We included studies reporting MC pregnancies complicated by sFGR undergoing SR with data on co-twin IUFD or neonatal demise and GA at delivery. A random-effect model estimated the pooled means and proportions and corresponding 95% confidence intervals (CI). X² compared outcomes between pregnancies managed with radiofrequency ablation (RFA) vs. Bipolar cord coagulation (BCC). The I² value assessed heterogeneity across studies.

Results:
A total of 21 studies, including 672 pregnancies, met the inclusion criteria and were eligible for quantitative synthesis. The overall rates of co-twin IUFD and neonatal demise were 14% (9-19) and 4% (2-7), respectively, and the GA at delivery was 35.4 weeks (34.3-36.5). Cases undergoing RFA had higher rates of co-twin IUFD than those undergoing BCC (20%, 95% CI 13-29 vs. 8%, 95% CI 4-15) (Figure 1). Co-twin neonatal demise rates were similar (BCC 5% 95% CI: 2-9 vs. RFA 3% 95% CI: 1-8). GA at delivery was lower in cases undergoing BCC, than those undergoing RFA (34.5 95% CI: 33.1-35.9 vs. 36.7 95% CI 35.2-38.4, respectively) (Figure 2).

Conclusion:
The risk of co-twin IUFD or neonatal demise in MC pregnancies complicated by sFGR who undergo SR is approximately 18%. BCC appears to be associated with lower rates of IUFD and earlier GA at delivery than RFA.