First‐trimester intervention in twin reversed arterial perfusion sequence

Sousa, M Tavares de; Glosemeyer, P.; Diemert, Anke; Bamberg, Christian

doi:10.1002/uog.20860

Cited by 43 publications

(55 citation statements)

References 10 publications

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“…They also identified gestational age at intervention and discordance between crown-rump length (CRL) of the pump twin and upper pole-rump length of the TRAP twin, measured as (CRL-URL)/CRL ratio and URL/CRL ratio, as predictive factors of pregnancy outcome. 22 A very recent work by Tavares de Sousa et al 23 reports a live birth rate of 92% at a median gestational age of 39 +6 (interquartile range 37 +1 to 41 +2 ) weeks in 12 TRAP cases treated before 14 +3 weeks. These differences in outcome may possibly be explained by variation in inclusion criteria, operative technique, as well as gestational age and fetal size even in the narrow interval between 11 and 15 weeks.…”

Section: Timing Of Interventionmentioning

confidence: 98%

<p>Twin Reversed Arterial Perfusion Sequence: Current Treatment Options</p>

Vitucci¹,

Fichera²,

Fratelli³

et al. 2020

IJWH

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Twin reversed arterial perfusion (TRAP) sequence is a specific and severe complication of monochorionic multiple pregnancy, characterized by vascular anastomosis and partial or complete lack of cardiac development in one twin. Despite its rarity, interest in the international literature is rising, and we aimed to review its pathogenesis, prenatal diagnostic features and treatment options. Due to the parasitic hemodynamic dependence of the acardiac twin on the pump twin, the management of these pregnancies aims to maximize the pump twin's chances of survival. If treatment is needed, the best timing of intervention is still debated, although the latest studies encourage intervention in the first trimester of pregnancy. As for the technique of choice to interrupt the vascular supply to the acardiac twin, ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels are usually the preferred approaches.

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Section: Timing Of Interventionmentioning

confidence: 98%

<p>Twin Reversed Arterial Perfusion Sequence: Current Treatment Options</p>

Vitucci¹,

Fichera²,

Fratelli³

et al. 2020

IJWH

View full text Add to dashboard Cite

show abstract

“…These findings prompted some centers to prepone the intervention to the 1 st trimester. So far only two studies have reported on TRAP treated in the 1 st trimester [6,7]. They focused on potential predictors for survival following intervention in the 1 st trimester, such as gestational age at intervention, crown-rump length (CRL) of the pump twin, upper pole-rump length (URL) of the TRAP twin, (CRL-URL)/CRL ratio, and URL/CRL ratio.…”

Section: Introductionmentioning

confidence: 99%

Outcome of TRAP Sequence Treated in the First Trimester – A Ten-Year Single-Center Experience

et al. 2021

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Purpose To evaluate the outcome of first trimester intervention by intrafetal laser (IFL) in pregnancies complicated by twin reversed arterial perfusion (TRAP). Materials and Methods For a 10-year study period, all patients with TRAP diagnosed < 14.0 weeks of gestation were retrospectively analyzed for intrauterine course and outcome. Monoamniotic pregnancies were excluded. Patients were offered either intervention by IFL in the first trimester, expectant management, or termination of pregnancy (TOP). Adverse outcome was defined as either intrauterine death (IUD), neonatal death, or preterm birth. Results In 45 cases TRAP was diagnosed. 17 monoamniotics were excluded. The cohort was divided into two groups according to management. Group A: 24 cases underwent IFL and group B: 4 cases were managed expectantly. No patient opted for TOP. In group A, 70.8 % of pump twins were born alive, including one preterm delivery, and 29.2 % died within four days after the intervention. All 4 expectantly managed cases in group B had an adverse outcome (1 preterm delivery, 3 IUDs < 15.0 weeks). There were no neonatal deaths. In cases treated by IFL, a comparison of survivors and non-survivors identified no significant differences in gestational age at IFL or any of the assessed biometrical and functional parameters. There was a trend towards better outcome in the second half of the study period. Conclusion IFL in first trimester TRAP sequence is technically feasible but is associated with significant mortality, albeit less than previously reported. No risk stratification is possible using the investigated parameters. However, there seems to be a learning curve.

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“…Clips metálicos. Se colocan clips en el cordón del feto acardio guiado por ecografía 24,31,32 y se realiza ligadura mediante fetoscopia 14,23,33,34 o tras exteriorizarlo por una pequeña histerotomía 26 .…”

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“…• Láser. Se realiza coagulación con láser 33,[35][36][37] o con fórceps bipolar 32 del cordón del feto acardio.…”

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Gran feto acardio: diagnóstico tardío de gestacion gemelar monocorial biamniótica complicada por secuencia TRAP. Reporte de un caso y revisión de la literatura

Ruiz

Álvarez

Miyares

et al. 2021

Rev. chil. obstet. ginecol.

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Objectives: to report the case of a patient with a monochorionic-biamniotic twin gestation complicated by TRAP sequence that gave rise to the birth of a pump fetus without anatomical malformations (1932 g) and an acardiac anceps fetus (1800 g), and to review this pathology and the importance of its early diagnosis and management. Materials and methods: the case of an acardiac fetus is presented in a pregnant woman without strict control at the Hospital San Pedro de Logroño in 2019, worthwhile because of its late diagnosis and high birth weight. A search of the literature was carried out in the Medline databases via PubMed, OVID, Embase and SciELO with the MeSH terms. As inclusion criteria, we considered series-type articles and case reports, cohorts and review articles from January 1950 to January 2020. Results: 39 bibliographic references were included with the main theoretical questions to be reviewed. Our acardiac fetus weight was very high comparing with the bibiography and without causing repercussion in the healthy fetus, which contributes to the uniqueness of the case, only the series report by Brassard et al ( 1999) is comparable, with weights of the acardiac fetus above 1700 grams and differing by 100 grams from the pump fetus. Conclusions: the acardiac fetus is an infrequent complication of monochorionic twin pregnancies. The presence of placental vascular anastomoses between both circulations is required. Early diagnosis is important to decrease morbidity and to use, as far as possible, non-invasive therapeutic techniques.

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First‐trimester intervention in twin reversed arterial perfusion sequence

Cited by 43 publications

References 10 publications

<p>Twin Reversed Arterial Perfusion Sequence: Current Treatment Options</p>

<p>Twin Reversed Arterial Perfusion Sequence: Current Treatment Options</p>

Outcome of TRAP Sequence Treated in the First Trimester – A Ten-Year Single-Center Experience

Gran feto acardio: diagnóstico tardío de gestacion gemelar monocorial biamniótica complicada por secuencia TRAP. Reporte de un caso y revisión de la literatura

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