P37.05: Treatment of TRAP sequence by percutaneous injection of absolute alcohol into the umbilical artery: A case report

Abstract

Poster abstracts increase chances of survival of the second twin. We report the case of a 27-year old primigravida presenting at 19 + 5 weeks of gestation with bulging membranes of the first dichoric twin. Due to the large prolapse an emergency cerclage proposed by the couple, was denied and conservative treatment with combined antibiotics and bed rest was proposed. The couple was informed about the poor prognosis. Two days after admission, rupture of membranes led to abortion of the first twin. Immediately after birth of the fetus, contractions ceased spontaneously. Within an interval of 12 hours, vaginal ultrasound revealed a cervical length of 40 mm with the umbilical cord passing through it. Within a few days paraclinical signs of infection normalised. At 20 + 6 gestational weeks abdominal ultrasound revealed opening of the cervical os to 1 cm. A cerclage and resection of the umbilical cord was performed. At 22 + 4 weeks of gestation the patient developed severe chorioamnionitis with increase of c-reactive protein and uterine contractions. Antibiotics could not control symptoms which led to abortion of the second twin at 22 + 5 gestational weeks. Conclusion: Due to universal accesibility of information via the internet, patients are aware of most, even experimental or anecdotal, therapeutical options. Extensive discussion of external evidence and individual examination results are necessary to meet the patients need for information. To accomplish this, clinical experience and knowledge of psychosomatic counselling are essential. Close monitoring by ultrasound is needed to detect complications.