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

Weber, E.; Recker, Florian; Gottschalk, Ingo; Strizek, Brigitte; Geipel, A.; Gembruch, U; Berg, Christoph

doi:10.1055/a-1526-1775

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…Figure 1 shows the study flow chart with included and excluded items (and the reasons for their exclusions). Forty-one articles were considered, including 194 cases of TRAP sequence [6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], 56 cases of BPSs [25][26][27][28][29][30][31][32][33][34][35][36], 5 cases of placental chorioangiomas (PCAs) [37][38][39], 11 cases of sacrococcygeal teratoma (SCT) [40][41][42][43], and 103 cases of ER in DCTA triplets treated using IFL [10,16,[44][45][46].…”

Section: Resultsmentioning

confidence: 99%

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Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

et al. 2022

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Introduction: Over the past years, intrafetal laser (IFL) therapy has been increasingly used in the management of various prenatal conditions. The aim of our research is to clarify the effectiveness and safety of this technique. Methods: A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001-2021). Results: A total of 41 articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPS), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. Preterm premature rupture of membranes (p-PROM) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) in 36 out of 122 pregnancies (29.5%). In BPS IFL was successfully performed in all cases with no significant complications. The rate of p-PROM and PTB were respectively 3.2% and 12.5%. All PCA IFL treated cases resulted in successful pregnancy outcomes; no cases of p-PROM were reported, but the rate of PTB reached a peak of 60% due to fetal complications. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); p-PROM occurred in two cases (18.2%), whereas the rate of PTB was 87.5%. In ER no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies. Discussion: Our analysis suggests that IFL is a feasible technique for the management of different fetal conditions. However, the overall risk of PTB and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT. This could aid in decision making during prenatal counselling. However final perinatal outcome depends on the severity of the disease itself.

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Section: Resultsmentioning

confidence: 99%

“…Of the 194 analyzed cases of TRAP sequence [6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], 150 were MCDA twins, 11 cases were DCTA triplets, 7 cases were MCTA triplets, 3 were MCMA twins, and 1 was an MCDA triplet (Table 2). Chorionicity was not specified for 22 twin pregnancies [22].…”

Section: Trap Sequencementioning

confidence: 99%

Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

et al. 2022

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“…Nevertheless, others have documented perinatal mortality of up to 55% in conservatively managed pump twins, a consequence of their high rate of high-output cardiac failure and very preterm birth [15, 18]. Given the advances in minimally invasive fetal therapy options, some authors propose that intervention should be moved into the first trimester, where small single-center reports have reported postoperative pump twin survival rates of 70–90% [16, 19]. Others prefer to delay an intervention until 16–18 weeks, with the premise that the risk of pregnancy loss may be lower after spontaneous obliteration of the celomic cavity [17, 20], accepting a risk of pump demise twin in up to 33% of cases during the period from diagnosis in the first trimester until an intervention in the second trimester [14].…”

Section: Discussionmentioning

confidence: 99%

The Management of Acardiac Twinning: Twin Reverse Arterial Perfusion Sequence – An International Survey

Molina-Giraldo¹,

Valencia²,

Johnson³

et al. 2023

Fetal Diagn Ther

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Introduction: The optimal approach and therapy method for the acardiac twin with a reverse arterial perfusion sequence has not yet been established. The aim of this study is to determine the clinical practice patterns amongst international fetal therapy units in their management of these cases. Methods: A survey was sent to fetal centers across the world via email between December 2020 and December 2021. Results: Responses were obtained from 77% contacted centers. The most frequent ultrasound variables used in the evaluation of TRAP sequence include echocardiographic assessment of the pump twin and umbilical artery Doppler waveforms in the acardiac and pump twins, in 90% and 80% of the centers respectively. Most centers in Europe and Latin America propose an in-utero intervention in all cases. Most centers in Europe and Latin America prefer interstitial laser ablation, whereas radiofrequency ablation is preferred in North America. The earliest gestational age for an intervention is on mean 13 weeks in Europe, which is earlier than the other geographic areas (p = 0.001). Conclusions: Most centers agreed that antenatal evaluation should include echocardiography along with the UA Doppler waveform measurements, and the most frequently used interventions were interstitial laser ablation or RFA at a median between 14 to 26 weeks.

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“…It may even be lower, as this review contained 26 pregnancies that underwent early selective feticide prior to 18 weeks. However, over the past decade, we preponed many of our interventions in monochorionic TRAP pregnancies into the first trimester using an intrafetal laser, with promising results [ 13 ]. Therefore, all TRAP pregnancies included in this cohort were diagnosed at a later gestational age, when an intrafetal laser is not suitable anymore.…”

Section: Discussionmentioning

confidence: 99%

“…In MC diamniotic pregnancies, feticide was performed by cord occlusion using bipolar optical coagulation forceps (11540 FG, Storz, Tuttlingen, Germany) introduced through an 11 Fr introducer as previously described ( Figure 1 ) [ 13 ]. We avoided septostomy in all procedures.…”

Section: Methodsmentioning

confidence: 99%

Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience

Weber

Strizek

Recker

et al. 2022

JCM

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Objectives: To review the outcome of complicated monochorionic pregnancies after fetoscopic selective feticide with bipolar cord coagulation in an experienced German center. Methods: All cases that underwent selective feticide using fetoscopic bipolar umbilical cord occlusion (and simultaneous dissection in monoamniotics) at the University of Bonn in the past 10 years were retrospectively analyzed for antenatal and neonatal course and outcome. An adverse outcome was defined as either intrauterine death (IUD), neonatal death (NND), preterm prelabour rupture of membranes (PPROM), or preterm delivery (PTD) before 32.0 weeks of gestation. Results: We diagnosed 56 monochorionic pregnancies, including 43 diamniotic and 8 monoamniotic twins, as well as 5 triplets, complicated by discordant fetal anomalies (n = 10), selective intrauterine growth restriction (n = 29), twin-to-twin transfusion syndrome (n = 13), twin reversed arterial perfusion sequence (n = 3), or severe early twin anemia polycythemia sequence (n = 1), that underwent fetoscopic selective feticide in the 10 years study period. Selective feticide was performed by bipolar cord coagulation at a median gestational age of 21.2 weeks. PPROM occurred in 11 cases, 7 (12.5%) before 32.0 weeks and 4 (7.1%) between 34.0 and 36.0 weeks, respectively. There were five (8.9%) co-twins IUDs at a median of 2 weeks after the intervention. We observed 12 (21.4%) PTDs before 32.0 weeks of gestation and 2 (3.6%) NNDs. Mean gestational age at delivery was 37.1 weeks, with an overall survival of the co-twin of 87.5%. Conclusion: In experienced hands, fetoscopic selective feticide is an effective treatment in complicated monochorionic pregnancies. By sacrificing a sick fetus that jeopardizes the entire pregnancy, a higher survival rate of the co-twin can be achieved.

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

Cited by 4 publications

References 10 publications

Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

The Management of Acardiac Twinning: Twin Reverse Arterial Perfusion Sequence – An International Survey

Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience

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