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

Abstract

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.

Terapia laser intrafetal para la secuencia perfusión arterial inversa en gemelos (TRAP). Comunicación de un caso y revisión de la literatura

“…El diagnóstico prenatal en la secuencia TRAP se realiza mediante ecografía bidimensional y se confirma mediante Doppler color. Sin embargo, la presencia de latidos fetales en el feto acárdico no descartaría el diagnóstico (4) . Dentro de las opciones terapéuticas, actualmente se prefiere el uso de técnicas por ablación intrafetal, entre las que resaltan la ablación por radiofrecuencia (RFA), procedimiento aún no disponible en el Perú, y el laser intrafetal.…”

“…La presencia de latidos fetales en este no descarta el diagnóstico, dado que según la forma y la ausencia de órganos internos se le puede clasificar morfológicamente como acéfalo (sin cabeza) (60 a 75%), amorfo (sin forma) (20%), anceps (sin cara) (10%) y acormus (sin tronco) (5%). Son factores de mal pronóstico la hidropesía, polihidramnios, Doppler anormal del gemelo 'bomba', relación peso gemelo acárdico / gemelo bomba > 70%, presencia de un cuerpo con extremidades superiores bien desarrolladas en el gemelo acárdico y embarazo monoamniótico (4) .…”

The Umbilical Cord and Complications of Twin Gestations

“…Because of their invasiveness, the application of endoscopic procedures has been reduced over the last few years to such an extent that they are now no longer used. IFL and RFA of the intrafetal vessels are usually the preferred approaches 79 …”

“…IFL and RFA of the intrafetal vessels are usually the preferred approaches. 79 Pagani et al 73 recommended elective treatment with IFL between 13 and 16 weeks of gestation. In their study, 17 TRAP pregnancies were treated with IFL; the neonatal survival rate was approximately 80%, with only 7% of preterm deliveries prior to 32 weeks of gestation.…”

Twin Reversed Arterial Perfusion Sequence: Prenatal Diagnosis and Treatment

“…Other differential diagnoses include intra-amniotic or placental tumors, such as chorioangioma, a placental cyst or teratoma, and an early single demise in an MC twin pregnancy. 18 An acardiac fetus is clinically divided into pseudocardiac (the presence of rudimentary cardiac structures) and halocardia (the absence of cardiac structures). It is widely classified into four different subgroups morphologically 19,20 : acardius acephalus (lacking cranial structures), acardius anceps (with rudimentary cranial structures), acardius acormus (only facial structures are present), and acardius amorphus (no recognizable form is present).…”