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Poster Session 4

Category: Fetal Intervention

Poster Session 4

(1021) Outcomes of elective versus medically-indicated radiofrequency ablation for multifetal reduction of monochorionic pregnancies

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Allison D. Perelman, MD (she/her/hers)

Fellow
Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai
New York, New York, United States

Coauthor(s)

Sara E. Edwards, MD (she/her/hers)

Fellow
Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai
New York, New York, United States
Nicola F. Tavella, CPH, MPH (he/him/his)

Clinical Research Program Director
Division of Maternal-Fetal Medicine, Icahn School of Medicine, Icahn School of Medicine at Mount Sinai Hospital
New York, New York, United States
AM

Ariana Mills, MD

Resident
Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai
New York, New York, United States
JD

Jordan Davis

Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai
New York, New York, United States
Manasa G. Rao, MD

Resident Physician
Columbia University
New York, New York, United States
KG

Kirema Garcia-Reyes, MD

Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai
New York, New York, United States
AB

Angela T. Bianco, MD

Professor and Division Director, Maternal-Fetal Medicine
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Joanne L. Stone, MD, MS

Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Science
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Chelsea A. DeBolt, MD, MSCR

Assistant Professor
Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai
New York, New York, United States

Objective:
We have previously demonstrated improved pregnancy outcomes in monochorionic (MC) twins who undergo multifetal reduction (MPR) via radiofrequency ablation (RFA) for an elective indication when compared to medically-indicated reduction, but this study was limited by small sample size. The current study aims to determine whether live birth rates differ for elective MPR (eMPR) compared to selective MPR (sMPR) via RFA in MC twins and higher order multiples in a large cohort.

Study Design:
This was a retrospective cohort study of MC pregnancies undergoing MPR via RFA between 2008 and 2025 at a single institution. eMPR was compared to sMPR which was defined as MPR for a complication of monochorionicity or fetal anomaly. Chi-squared and Fisher’s exact tests compared proportional differences, and multivariable logistic regression models were used to estimate the likelihood of live birth.

Results:
Of 115 patients included, there were 62 (54%) eMPRs and 53 (46%) sMPRs. 35 (66%) of the sMPRs were for MC complications and 18 (34%) for fetal anomalies. eMPRs occurred at an earlier gestational age (15 vs 18 weeks, p< 0.001). Many subjects were referred from outside institutions, and pregnancy outcomes were known for 50 (81%) of the elective group and 42 (81%) of the selective group. In an unadjusted analysis of those with known pregnancy outcomes, eMPR had a significantly higher live birth rate (92% vs 72%, p< 0.05) and lower rate of small for gestational age newborn (22% vs 5%, p< 0.05) (Table 2). When adjusting for possible confounders, the likelihood of live birth remained significantly higher in the eMPR group (aOR 4.8, 95% CI 1.20-33.13).

Conclusion:
In a retrospective cohort, elective reductions occurred at a significantly earlier gestational age. When adjusting for this, elective reductions remained significantly more likely to result in live birth when compared to selective reductions. Patients should be counseled that should they chose to pursue MPR at an earlier gestational age before complications of MC arise, they may have a higher chance of live birth.