Tailored management of twin reversed arterial perfusion (TRAP) sequence

Weisz, Boaz; Peltz, R.; Chayen, Benjamin; Oren, M.; Zalel, Yaron; Achiron, Reuven; Lipitz, Shlomo

doi:10.1002/uog.1040

Cited by 79 publications

(52 citation statements)

References 31 publications

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“…In the combined data from previous studies [51,52,53,54,55,56,57,58,59,60] and the current study there were 104 twin pregnancies treated by intrafetal laser. There was no significant association between the gestational age at treatment and survival rate (mean 77.9%, r = 0.066, p = 0.508).…”

Section: Resultsmentioning

confidence: 99%

“…Early attempts were highly invasive and involved hysterotomy and removal of the acardiac twin [2,3,4]. Subsequently, a series of other less invasive intrauterine interventions aiming to arrest the circulation of the acardiac twin were introduced [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. These included insertion of cord coils, ligation with or without transection of the umbilical cord, endoscopic laser coagulation of placental anastomoses between the pump and acardiac twins, endoscopic laser coagulation and endoscopic or ultrasound-guided monopolar or bipolar diathermy of vessels within the cord supplying the acardiac twin and, more recently, ultrasound-guided ablation of intrafetal vessels by injection of alcohol, monopolar diathermy, laser or radiofrequency.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

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Introduction: The objective of this study was to define the optimal method and timing of intervention in twin reversed arterial perfusion (TRAP) sequence. Material and Methods: During a period of 20 years (1993-2013), we performed endoscopic laser coagulation of umbilical cord vessels or intrafetal laser in 67 pregnancies with TRAP sequence. These data were combined with those reported in the literature to determine the survival rate of the pump twin for different methods and timing of interventions. Results: A variety of techniques were used to interrupt the blood supply to the acardiac twin. Most procedures were performed at or after 16 weeks, and with most methods the survival rate of the pump twin was about 80%. Good results were also obtained for triplet pregnancies. In 18 of 30 cases (60%) diagnosed at 11-14 weeks, there was spontaneous cessation of flow in the acardiac twin before planned intervention at 16-18 weeks, and in 11 of these (61.1%) the pump twin died or suffered brain damage. In 103 pregnancies treated by intrafetal laser at 12-27 weeks, there was no correlation between gestational age at treatment and survival rate, but there was an inverse association between gestational age at treatment and gestational age at birth. Discussion: In TRAP sequence, survival may be improved by elective intervention at 12-14 weeks.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

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“…Conservative treatment is best suited for salvation of the pump twin when the acardiac twin is less than 70% of the pump twin weighs and there are no sign of impending heart failure. 23 …”

Section: Resultsmentioning

confidence: 99%

Acardiac Twin: A Rare Case Report

Saleh¹

2017

MOJWH

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Twin reversed arterial perfusion sequence (TRAP), refers to a rare, unique complication of mono-chorionic twin pregnancy in which a twin with an absent or a nonfunctioning heart (acardiac twin) is perfused by its co-twin (pump twin) via placental arterial anastomoses. The acardiac twin usually has a poorly developed heart, upper body and head. The pump twin is at risk of heart failure and problems related to preterm birth. This case report presents an antenatally diagnosed mono-chorionic twin pregnancy, resulting in preterm delivery of a healthy, normal twin along with an acardiac co-twin.

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“…Because the blood first perfuse the lower segment of the anomalous twin, the lower limbs and genitalia receive comparatively more oxygen than the upper segment of the body. 6,7 The mortality of the cardiac twin is 100%, and the perinatal mortality of the pump twin is reported to be around 50%. The poor outcome of the pump twin is primarily due to congestive heart failure, cord entanglement or prematurity.…”

Section: Discussionmentioning

confidence: 99%

Twin Reversed Arterial Perfusion Syndrome: A Rare but Critical Event of Twin Pregnancy

Singh

Mishra

Bano

2015

Int J Reprod Contracept Obstet Gynecol

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Tailored management of twin reversed arterial perfusion (TRAP) sequence

Abstract: Objective To describe our management of pregnancies complicated by twin reversed arterial perfusion (TRAP) sequence.Methods This was a retrospective study involving all cases of TRAP sequence referred to our fetal medicine unit in a 3-year period (2000)(2001)(2002)

Cited by 79 publications

References 31 publications

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Acardiac Twin: A Rare Case Report

Twin Reversed Arterial Perfusion Syndrome: A Rare but Critical Event of Twin Pregnancy

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