Abstract： Objective To assess the effectiveness of radiofrequency ablation (RFA) in the treatment of multiple pregnancies. Methods In this retrospective study, 84 cases (total 174 fetuses) of complex monochorionic pregnancies treated with RFA for selective fetal reduction were analyzed. All cases were managed in the Guangdong Women and Children Hospital from January 2015 to January 2018. Indications for offering RFA, details of the procedure and pregnancy outcomes were collected and analyzed. Results (1)The rate of miscarriage and fetal intrauterine death was 21% (18/84), termination of pregnancy because of fetal malformation or oligohydramnion occurred in 10% (8/84) of cases. Total live birth rate was 69% (58/84) and the gestation age at delivery was (35.0±3.0) weeks. (2) The live birth rate of twin reversed arterial perfusion sequence (TRAPS) was the lowest (6/11), followed by twin to twin transfusion syndrome (TTTS; 66%, 27/41), structural or genetic abnormalities of one fetus in monochorionic twin pregnancy (10/14), triplet pregnancy reduction (4/6) and selective intrauterine growth restriction (sIUGR) (11/12). (3) The live birth rate was 67% (20/30) in stage Ⅲof TTTS and 7/11 in the stage Ⅳof TTTS (P>0.05). The average gestational age was (33.6±3.0) weeks in stageⅢof TTTS compared with (36.5±2.4) weeks in the stageⅣof TTTS (P<0.05). Conclusions RFA appears to be a reliable option for selective fetal reduction in monochorionic multiple pregnancies. The indication of RFA is an influencing factor on its pregnancy outcomes. TypeⅡand typeⅢsIUGR may choose this technique as a priority. Compared with stageⅢof TTTS, the live birth rate and the gestation age at delivery in stageⅣof TTTS, there are no significant differences.