OP22.06: Cord occlusion in complicated monochorionic (MC) multiple pregnancies: A comparison of techniques
Bibliographic record
Abstract
To compare different methods of cord occlusion in complicated MC pregnancies. Single centre retrospective cohort study (Aug 97–Feb 08) of all MC pregnancies undergoing cord occlusion of one abnormal twin. Cord occlusion was performed in 30 cases (2 sets of triplets). Indications were: TRAP (10), severe TTTS with one significantly compromised twin (6), discordance for a major fetal anomaly (14). We used 6 techniques: cord ligation (CL) (1), unipolar cautery (UC) (1), bipolar cautery (BC) (9), ultrasound guided laser (USL) (5), fetoscopic laser (FL) (4), radiofrequency ablation (RFA) (10). RFA was the fastest procedure, compared to BC (P = 0.0002), USL (P < 0.0001) and FL (P = 0.0003). RFA's were done earliest (15.3–23 wks), and had a longer latency to delivery compared to BC (P = 0.3), USL (P = 0.15) and FL (P = 0.14). To date, only one RFA patient delivered < 32 wks. PPROM < 30 wks occurred only once (BC) at 23 wks, but delivery occurred at 36 wks. One FL survivor (born at 26 wks) has cerebral palsy and one USL survivor (born at 30 wks) is developing normally, despite porencephalic changes on imaging. The UC cord recanulized despite having no flow 1 hr after the procedure. Two BC's “failed”: one had a successful FL and the other was abandoned mid-procedure at patient's request and carried to term (the severely hydrocephalic neonate died). One FL failed and had a successful BC. Cord occlusion should always be considered when faced with imminent and/or predictable death of a MC twin, particularly at very early gestations. In our experience, RFA is the technique of choice for selective termination in a complicated MC pregnancy; it uses a small instrument (17 G), is the fastest, has fewest complications and has the longest latent interval to delivery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".