Perinatal outcomes after selective feticide via umbilical cord occlusion in complicated monochorionic pregnancies: A systematic review and meta‐analysis.

Objective: We aimed to compare perinatal outcomes between umbilical cord occlusion techniques in monochorionic pregnancies, including umbilical cord ligation, fetoscopic laser coagulation, interstitial laser coagulation, bipolar cord occlusion, radiofrequency ablation, and microwave ablation. Methods: This study was registered with PROSPERO (CRD42020158861). PubMed, Web of Science, Cochrane Library, and Embase were searched for studies published up to May 2020. The DerSimonian‐Laird random‐effects model was used for the meta‐analysis. Subgroup analyses were performed to compare the outcomes among the six techniques. Meta‐regression was used to adjust for confounders. Results: Thirty‐four studies with 1646 participants were included. The overall survival was 76.5% after umbilical cord ligation, 78.8% after fetoscopic laser coagulation, 60.3% after interstitial laser coagulation, 79.2% after bipolar cord occlusion, 77.5% after radiofrequency ablation, and 75.0% after microwave ablation. Subgroup comparison showed the rates of overall survival and preterm premature rupture of membranes were not significant different among six techniques. However, rates of fetal loss, premature birth, live birth, and neonatal death differed significantly among the six groups. Conclusions: The choice of umbilical cord occlusion techniques will affect perinatal outcomes. We suggested that the choice of umbilical cord occlusion techniques should fully consider these differences among techniques. Key points: What's already known about this topic? Several techniques have been used for selective feticide of monochorionic pregnancies.Bipolar cord occlusion and radiofrequency ablation are two commonly used minimally invasive methods for selective feticide.However, whether the pregnancy outcomes are different among different techniques is still unknown. What does this study add? This is the first meta‐analysis comparing perinatal outcomes among six techniques of selective feticide in monochorionic pregnancies.Our findings showed that the overall survival rate after umbilical cord occlusion was 77.1% (95% CI: 73.9%–80.2%).Besides, fetal loss, premature birth, live birth, and neonatal death rates differed significantly among the six techniques.Our study suggested that the choice of umbilical cord occlusion should fully consider the difference in perinatal outcomes among procedures. [ABSTRACT FROM AUTHOR]