Korean J Obstet Gynecol.  2012 Aug;55(8):552-558. 10.5468/KJOG.2012.55.8.552.

Perinatal outcome of twin reversed arterial perfusion sequence: A single center's experience

• Lee MY
• Won HS
• Lee KA
• Kyeong KS
• Jeon EJ
• Shim JY
• Lee PR
• Kim A

• KMID: 2078104
• DOI: http://doi.org/10.5468/KJOG.2012.55.8.552

Abstract

OBJECTIVE
To report our experience of using radiofrequency ablation (RFA) to treat fetuses diagnosed with twin reversed arterial perfusion (TRAP) sequence and to evaluate the perinatal outcome of pump twins.
METHODS
Twenty-six fetuses diagnosed with the TRAP sequence were retrospectively analyzed between July 1998 and September 2011 at Asan Medical Center. Four were lost to follow-up after diagnosis and, therefore, were excluded from further evaluation. The perinatal outcomes of pump twins were evaluated by reviewing the medical records.
RESULTS
Twenty-two fetuses were diagnosed with the TRAP sequence during the study period, including 15 monochorionic-diamniotic pregnancies and four monochorionic-monoamniotic pregnancies. Three patients had triplet pregnancies. The median gestational age at diagnosis was 17.4 weeks (range, 11.0 to 27.0 weeks). Of these 22 cases, in utero RFA was performed in 11 (50%), alcohol ablation in one (4.5%) and the remaining 10 (45.5%) underwent conservative management. The median gestational age at in utero intervention was 21.0 weeks (range, 17.6 to 25.0 weeks). The overall neonatal survival rate was 77% (17 of 22). The median gestational age at delivery was 37.3 weeks (range, 30.2 to 40.1 weeks). All of the surviving infants are doing well without any complications.
CONCLUSION
For fetuses with the TRAP sequence, proper in utero treatment with RFA enables to continue the pregnancy with a good prognosis.

Keyword

Twin reversed arterial perfusion sequence; Acardiac twin; Radiofrequency ablation; Fetal therapy

MeSH Terms

Fetal Therapies
Fetus
Gestational Age
Humans
Infant
Lost to Follow-Up
Perfusion
Pregnancy
Pregnancy, Triplet
Prognosis
Retrospective Studies
Survival Rate

Figure

• 

  Fig. 1 Radiofrequency ablation (RFA) technique. (A) The RFA needle must be inserted at the level of umbilical cord insertion, which can be easily detected using color Doppler. Ultrasonographic finding demonstrates a single umbilical artery. (B) During RFA, the effects of ablation can be seen by observing the echogenic area around the ablation site. (C) After successful ablation, the cessation of blood flow can be confirmed by color Doppler.

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