Outcome of Twin Reversed Arterial Perfusion Sequence following Treatment with Interstitial Laser: A Retrospective Study

Abstract

Objectives: To determine the outcome of twin reversed arterial perfusion (TRAP) sequence treated with or scheduled for treatment with interstitial laser therapy. Methods: This is a retrospective study on ten pregnancies diagnosed with TRAP sequence. Seven of the ten pregnancies were treated with interstitial laser therapy, and two pregnancies were scheduled for later treatment. One pregnancy was treated with fetoscopic laser ablation and excluded from analysis. The delivery reports of all pregnancies were collected, the neonatal health status recorded and the median time of delivery and the treatment to delivery interval calculated. Results: Six of seven pump fetuses in TRAP pregnancies treated with interstitial laser therapy at a median of 16+2 (range 13+1 to 20+3) gestational weeks were born healthy at a median of 38+0 (range 34+3 to 40+6) gestational weeks. One fetus treated with interstitial laser died after the procedure at 20+3 weeks. Two pump twins scheduled for later treatment died before the gestational age of 16 weeks. The median treatment to delivery interval for the surviving fetuses was 153 days (range 128-194). Conclusion: Treatment of TRAP sequence by interstitial laser therapy is feasible from the 13th week of gestation and has a good outcome.