P18.11: Twin reversed arterial perfusion sequence: a 14‐year experience in a tertiary referral centre

Abstract

The aim of this study is to review all cases of Twin reversed arterial perfusion (TRAP) sequence managed in a tertiary referral center and to compare the outcome in conservatively managed cases with that of those managed with interventions. This is a retrospective study analyzing all TRAP cases that were managed in a tertiary center from Jan 2000 to October 2013. Details assessed included (1) Gestation at diagnosis (2) Ultrasound features at Diagnosis (3)Treatment options offered (4) Outcome of these pregnancies and (5) Prognostic factors. Wherever possible, the outcomes and prognostic factors were compared between the groups with different management strategies. 59 cases of TRAP were identified during the study period. Follow up was available in 46(77%), among a total of 59 pregnancies complicated by TRAP sequence. Among, these 17 (37.8%) opted for elective termination of pregnancy and 29 (62.2%) continued their pregnancies. Among these 29 women who continued their pregnancies 10 were managed expectantly and 19 had an intervention for the twin with TRAP sequence. The intervention techniques used were alcohol ablation, coil embolization and interstitial laser coagulation. The overall survival rate in the group that had an expectant management was 80% and the mortality rate of the pump twin was 20%. The overall survival rate in the intervention group was 57.8% and the mortality rate was 36.8%. When intra fetal laser was used as the treatment of choice for TRAP sequence the survival rate was 82%.