Intervention versus a conservative approach in the management of TRAP sequence: a systematic review

Mone, Fionnuala; Devaseelan, Priscilla; Ong, Stephen

doi:10.1515/jpm-2015-0165

Cited by 19 publications

(14 citation statements)

References 45 publications

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“…In the largest series on the outcome of 49 acardiac twin pregnancies without intrauterine surgical treatment the mortality rate was 51% and only 24% of the patients delivered after 36 gestational weeks [6]. Other studies described a 50-70% mortality rate without adequate treatment [7,8].…”

Section: Discussionmentioning

confidence: 97%

Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

et al. 2018

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Twin reversed arterial perfusion (TRAP) sequence is a rare and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). We report on the case of a33-year-old female with a biamniotic monochorionic twin pregnancy complicated with TRAP sequence and polyhydramnios. The patient underwent fetoscopic termination of the acardiac twin and at 34 gestational weeks (GW) was readmitted with aretroplacental hematoma. The patient gave birth through caesarean section to a living female fetus, weighing 1480 g. To the best of our knowledge, this is the first case reporting a twin pregnancy with TRAP sequence complicated with retroplacental hematoma.

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Section: Discussionmentioning

confidence: 97%

Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

et al. 2018

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“…4, 26,27,[30][31][32] As odds with dichorionic twins, lethal malformations in MC twins can hardly be managed expectantly. 1 A systematic review of the literature reported a 12% (95% CI [7][8][9][10][11][12][13][14][15][16][17][18], P = .02) risk of the healthy survivor's demise following its abnormal co-twin's death 33 (Table 3). However, SF may increase the risk of losing the whole pregnancy in up to 5% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…There are three main options for managing cases of MC twins discordant for congenital anomalies (DCA): expectant management (EM), selective feticide (SF), or termination of the entire pregnancy (TOP). With EM, the potential loss of a malformed MC twin exposes the co-twin to intrauterine demise (10%-25%) or neurological injury (24%-45%) 8,9 whereas SF is not always safe and could result in the loss of the whole pregnancy in 5% of the cases. 10 To our knowledge, there is no study showing that one particular strategy is better than the other.…”

Section: Introductionmentioning

confidence: 99%

Management of monochorionic twins discordant for structural fetal anomalies

et al. 2020

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Objective: To review the perinatal management and outcomes of monochorionic twin pregnancies (MC) discordant for congenital anomalies (DCA). Methods: Retrospective, study of all MC DCA cases referred to our tertiary referral center from 1997 to 2018. We excluded cases complicated with twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, twin reversed arterial perfusion sequence or selective intra-uterine growth restriction. Patients were counseled about the possibility of expectant (EM) or interventional management (selective feticide [SF] or termination of the entire pregnancy [TOP]). Results: One hundred eight of 4157 (2.6%) MC pregnancies were discordant for anomaly. Fifty two of 108 n(48.1%) underwent SF at a mean gestational age of 31.4 ± 5.9 weeks while 52/108(48.1%) opted for EM. Livebirth rate of the healthy co-twin was similar between the two groups (SF: 88.5% vs EM: 82.7%, P = .87). In the SF group, six healthy co-twins (6/52, 11.5%) died 5.3 ± 3.1 days after SF of the abnormal co-twin. In the EM group, in-utero demise of the abnormal twin occurred in 9 of 52 (17.3%) of the cases and was followed by the spontaneous demise of the healthy co-twin in 4 of 9 (44.4%) of these cases. Conclusion: Selective feticide does not seem to significantly alter survival of the healthy co-twin compared to EM.

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“…If the TRAP sequence is left untreated, a substantial proportion of pump twins die in utero up to 18 weeks of gestation, and 50% of the remainder die in the further course of pregnancy or in the neonatal period as a result of prematurity [ 12 ]. These fetal intervention techniques target the umbilical cord vessels, the intrafetal vessels, or the vascular anastomoses on the placental surface [ 12 , 13 ]. The optimal treatment technique and timing of intervention in pregnancies complicated with TRAP sequence are still debated [ 1 – 3 ].…”

Section: Introductionmentioning

confidence: 99%

Intestinal volvulus in the pump twin of a twin reversed arterial perfusion (TRAP) sequence after laser therapy at 18 weeks: a case report

et al. 2020

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Background: Twin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin. Case presentation: A 32-year-old Hispanic primigravida was referred to our clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical "whirlpool sign" at 26 weeks of gestation, and intrauterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm premature rupture of membranes occurred, and an emergency cesarean section was performed. The newborn was diagnosed in the early neonatal period with intestinal perforation. The diagnosis was postnatally confirmed by surgery and histopathology. Conclusions: The type of fetal intervention and late gestational age of the procedure increase the risk of complications. This case alerts health providers to be vigilant in the follow-up of patients with complicated monochorionic pregnancies.

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Intervention versus a conservative approach in the management of TRAP sequence: a systematic review

Cited by 19 publications

References 45 publications

Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

Management of monochorionic twins discordant for structural fetal anomalies

Intestinal volvulus in the pump twin of a twin reversed arterial perfusion (TRAP) sequence after laser therapy at 18 weeks: a case report

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