The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature

Cabassa, Paolo; Fichera, A.; Prefumo, Federico; Taddeï, F.; Gandolfi, Silvia; Maroldi, Roberto; Frusca, T.

doi:10.1016/j.ejogrb.2012.10.009

Cited by 55 publications

(53 citation statements)

References 17 publications

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“…The preterm delivery rate before 34 weeks was 23.1% with only 1 neonate who died of prematurity. Subsequently, there were at least 8 other case series with varying sample sizes [5,15,16,17,18,19,20,21,22]. The largest series has recently been published with a sample size of 98 cases [22], though it might have included some cases from previously published series [15,16,18,20,21].…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Ting²,

Law³

et al. 2013

Fetal Diagn Ther

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Objective: To evaluate the perinatal outcome of monochorionic (MC) multiple pregnancies after selective reduction by radiofrequency ablation (RFA). Methods: A case series of all MC multiple pregnancies with selective reduction by RFA in one single institution was reviewed. Results: Ten consecutive patients with an MC pregnancy (9 pairs of twins and 1 set of triplets) underwent RFA. The median gestational age at the time of the procedure was 15.6 weeks (range, 12.3-19.6). The indications for selective reduction included discordance for fetal anomalies (4 cases), twin reversed arterial perfusion sequence (3 cases), selective intrauterine growth restriction (2 cases) and severe twin-twin transfusion syndrome (1 case). All procedures were technically successful in achieving selective reduction. The overall survival rate of the co-twin was 81.8% (9/11), and the median gestational age at delivery was 35.9 weeks (range, 32.4-38.6). There was one preterm delivery before 34 weeks of gestation (11.1%). Preterm premature rupture of the membranes occurred in 2 patients (20%); however, this was not observed within 4 weeks postoperatively, nor did they deliver before 32 weeks. Conclusions: RFA is a promising technique for selective reduction in complicated MC multiple pregnancies with a high survival rate and low complication rate.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Ting²,

Law³

et al. 2013

Fetal Diagn Ther

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“…The vessel occlusive procedures available include fetoscopic cord ligation, laser coagulation, bipolar cord cauterization, ablation using radiofrequency or with absolute alcohol, and selective delivery of acardiac twin. Short-term outcome studies generally report a survival of 80%-90% for the pump twin after these in utero coagulation/ablation procedures [12,13] .…”

Section: Discussionmentioning

confidence: 99%

“…The classically reported incidence of TRAP sequence is 1/35,000 pregnancies [1,2,4,6,[10][11][12][13][14] and most of these cases occur in monozygotic twin gestations. Acardius in triplet gestations constitutes only 8% of all acardiac cases and there have been fewer than 20 such cases described in the literature thus far [8] .…”

Section: Discussionmentioning

confidence: 99%

A case of twin reversed arterial perfusion (TRAP) sequence in a monochorionic diamniotic triplet pregnancy with two acardiac fetuses

May

Lanni

Jakowski

2016

IJDI

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Background: Twin reversed arterial perfusion (TRAP) sequence is a rare anomaly of monochorionic twins involving artery-to-artery anastomoses resulting in a structurally normal "pump" twin that provides circulation to an acardiac twin in a retrograde fashion.Case: Herein we report a rare case of a triplet gestation (TrGA) consisting of two conjoined acardiac TRAP recipients and one surviving normal pump fetus. The TRAP recipients were discordant for their anomalies. We know of only three similar case reports from the literature. Conclusion:Characteristic ultrasound findings allow for the prenatal diagnosis of TRAP sequence and may allow prompt and appropriate treatment to improve the outcome of the pump twin.

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“…Laser and RFA are relatively comparable, with neonatal survival rates of 82% and 85%, respectively. [7,9] The choice of treatment should be based on operator experience, gestational age and accessibility. [3] The ideal timing of in utero intervention remains controversial; procedures have been reported between 12 and 27 weeks of pregnancy, is usually performed at the beginning of the second trimester (16 weeks).…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis of an Acardiac Twin in the First Trimester, A Case Report.

Vasconcelos¹,

Rosado²,

Cohen³

et al. 2017

Int J Med Rev Case Rep

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Background:Twin reversed arterial perfusion (TRAP) sequence is a rare monochorionic twin pregnancy complication. It should be suspected in the first-trimester ultrasound when one fetus has no cardiac activity in monochorionic pregnancies. Doppler study is essential for early diagnosis of acardiac twin. This manuscript shows the importance of reassessing cases considered as vanishing twins in early pregnancy, to avoid a late diagnosis of acardiac twin, without timely treatment. Case Summary: In this case, the assumption of the death of one fetus in the first trimester, delayed the correct diagnosis of TRAP until 25 weeks, when the case was referred to our unit. We opted conservative management with weekly ultrasound surveillance, looking for features of heart failure in the pump twin. After suspecting fetal anaemia, at 32 weeks a healthy baby weighing 2100g was delivered along with an acardiac anceps with 518g. This is a case of expectant management, for lack of another option, to a successful end. Conclusion: Although twin reversed arterial perfusion (TRAP) sequence being a rare monochorionic twin pregnancies complication, it should be suspected in the first-trimester ultrasound, when detected monochorionic pregnancies and one embryo/fetus has no cardiac activity. Follow up in the fetal death of one twin in monochorionic pregnancies must be done with Doppler to look for an acardiac twin. Because pump twin may develop a high-output cardiac failure and intrauterine fetal demise, for continuing pregnancies without poor prognostic criteria, it is important to maintain weekly ultrasound surveillance, with attention to the intervention criteria.

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The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature

Cited by 55 publications

References 17 publications

Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

Radiofrequency Ablation for Selective Reduction in Complicated Monochorionic Multiple Pregnancies

A case of twin reversed arterial perfusion (TRAP) sequence in a monochorionic diamniotic triplet pregnancy with two acardiac fetuses

Misdiagnosis of an Acardiac Twin in the First Trimester, A Case Report.

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