OP-09 Treatment modalities in twin reversed arterial perfusion

Objective

This study’s objective was to examine the follow-up and treatment modalities applied to four cases of twin reversed arterial perfusion(TRAP) sequences observed in monochorionic twin pregnancies.

Methods

Four cases diagnosed with TRAP who applied to the perinatology clinic of Necmettin Erbakan University Meram Faculty of Medicine between 2019 and 2022 were included in the study. Written informed consent was obtained from all patients to present the cases. A karyotype study was performed on all cases, and the other baby was found to be healthy. Four cases were acardiac twins. The diagnosis of TRAP was confirmed in all cases by demonstrating the retrograde perfusion from the pump twin to the acardiac twin using color flow Doppler. Perinatal outcomes of all cases were evaluated.

 Results

The mean maternal age of the patients was 27.3 ± 6.08 years. The mean week of procedure was 18.5 ± 4.04, mean week of delivery was 31.7 ± 4.16. The time between the procedure and delivery was 13.2± 6.8 weeks. Cord coagulation was performed in the first case in the 24th week, and an 1100 g baby was delivered by cesarean .

Discussion

TRAP occurs in 1% of monochorionic pregnancies, 1 in 35000 of all pregnancies.It is characterized by the presence of a TRAP or acardiac mass perfused by an apparently normal (pump) twin. The risk of death of the pump fetus in the conservatively managed TRAP sequence is 30% at 18 weeks of gestation. Intrauterin fetoscopic methods such as cord coagulation, cord ligation, photocoagulation, RFA, and intrafetal laser therapy are used to prevent the death of the pump fetus.

Conclusion

Treatment modalities should be planned according to the gestational week, technical possibilities, and the experience of the team. It should be known that the morbidity of a healthy baby may increase due to premature birth in fetoscopic procedures.

Keywords

Cord coagulation, intrafetal laser, trap

1. Berg C, Holst D, Mallmann MR, Gottschalk I, Gembruch U, Geipel A. Early vs late intervention in twin reversed arterial perfusion sequence. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2014;43(1):60-64.
2. Tavares de Sousa M, Glosemeyer P, Diemert A, Bamberg C, Hecher K. First-trimester intervention in twin reversed arterial perfusion sequence. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2020;55(1):47-49.

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