Abstract
Objective: To define optimal method and timing of intervention in twin reversed arterial perfusion (TRAP) sequence.
Methods: During 20 years (1993-2013) we performed endoscopic laser coagulation of umbilical cord vessels or intrafetal laser in 67 pregnancies with TRAP sequence. These data were combined with those reported in the literature to determine survival rate of the pump twin for different methods and timing of interventions.
Results: A variety of techniques were used to interrupt the blood supply to the acardiac twin. Most procedures were performed at or after 16 weeks and with most methods the survival of the pump twin was about 80%. Good results were also obtained for triplet pregnancies. In 18 of 30 (60%) of cases diagnosed at 11-14 weeks, there was spontaneous cessation of flow in the acardiac twin before planned intervention at 16-18 weeks and in 11 (61.1%) of these the pump twin died or suffered brain damage. In 103 pregnancies treated by intrafetal laser at 12-27 weeks, there was no correlation between gestation at treatment and survival rate, but there was an inverse association between gestation at treatment and gestation at birth.
Conclusion: In TRAP sequence, survival may be improved by elective intervention at 12-14 weeks.
Methods: During 20 years (1993-2013) we performed endoscopic laser coagulation of umbilical cord vessels or intrafetal laser in 67 pregnancies with TRAP sequence. These data were combined with those reported in the literature to determine survival rate of the pump twin for different methods and timing of interventions.
Results: A variety of techniques were used to interrupt the blood supply to the acardiac twin. Most procedures were performed at or after 16 weeks and with most methods the survival of the pump twin was about 80%. Good results were also obtained for triplet pregnancies. In 18 of 30 (60%) of cases diagnosed at 11-14 weeks, there was spontaneous cessation of flow in the acardiac twin before planned intervention at 16-18 weeks and in 11 (61.1%) of these the pump twin died or suffered brain damage. In 103 pregnancies treated by intrafetal laser at 12-27 weeks, there was no correlation between gestation at treatment and survival rate, but there was an inverse association between gestation at treatment and gestation at birth.
Conclusion: In TRAP sequence, survival may be improved by elective intervention at 12-14 weeks.
| Original language | English |
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| Article number | N/A |
| Pages (from-to) | N/A |
| Number of pages | 13 |
| Journal | Fetal Diagnosis and Therapy |
| Volume | N/A |
| Issue number | N/A |
| DOIs | |
| Publication status | E-pub ahead of print - 2014 |